NPIMap

Organization Active NPI

Jefferson Comprehensive Care System, Inc

  • Federally Qualified Health Center (FQHC)
  • Little Rock, AR
National Provider Identifier
1457054769
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Practice address
1724 Bishop St
Little Rock, AR 72202-6022
Phone
(870) 543-2300
NPI assigned
Mar 24, 2023
Last updated
Mar 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JEFFERSON COMPREHENSIVE CARE SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sandra J. Brown
Title
Ceo
Phone
(870) 543-2380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1724 Bishop St
Little Rock, AR 72202-6022

Mailing address

PO Box 1285
Pine Bluff, AR 71613-1285
Phone (870) 543-2300

Other names 1

  • Jefferson Comprehensive Care System, Inc- ABC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240315000690 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193634509 Practice locations: Little Rock, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457054769. Details of each certification follow.

Federally qualified health center certification: CCN 041051

Legal name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 19, 2024
Last certification
Feb 19, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 2023 in AR
Enrollment address
1724 Bishop St
Little Rock, AR 72202-6022

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Pine Bluff Health Clinic

Locations

309 S Edline
Altheimer, AR 72004
Phone (870) 543-2380

1100 N University Ave
Ste 125
Little Rock, AR 72207
Phone (501) 663-0055

1225 Martin Luther King Dr
Little Rock, AR 72202
Phone (501) 244-2121

1400 Main St
Little Rock, AR 72202
Phone (501) 371-0055

1522 W 10th St
Little Rock, AR 72202
Phone (501) 376-1295

3000 Springer Blvd
Little Rock, AR 72206
Phone (870) 536-5576

3000 Springer Blvd
Ste B
Little Rock, AR 72206
Phone (501) 244-2121

2525 Willow St
#1
North Little Rock, AR 72114
Phone (870) 543-2300

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Monica Williams Individual Corporate Officer Mar 1, 2023
Lillie Reeves Individual Corporate OfficerBoard Member Mar 1, 2023
Eduardo R. Ochoa Individual Corporate OfficerBoard Member Mar 1, 2023
Bonita Corbin Individual Corporate Officer Mar 1, 2023
Cheryl Broughton Individual Corporate OfficerBoard Member Mar 1, 2023
Edward Davis Individual Corporate Officer Mar 1, 2023
Chanda Evans-McField Individual Corporate DirectorCfo Feb 1, 2010
W-2 Managing Employee Feb 2, 2010
Sandra J Brown Individual Corporate DirectorCeo Feb 2, 2009
Jefferson Comprehensive Care System, Inc Organization, Pine Bluff, AR Medical provider/supplier, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Nov 30, 1972
Zackery Tallaferro Individual Corporate Officer Mar 1, 2023
William Burney Individual Corporate OfficerBoard Member Mar 1, 2023
Jerry Malone Individual Corporate Officer Mar 1, 2023
Linzie Anderson Individual Corporate Officer Mar 1, 2023
Marie Lindquist Individual Corporate Officer Mar 1, 2023
Earnestine Daniels Individual Corporate OfficerBoard Member Mar 1, 2023

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Downtown Little Rock Community Health CenterLittle Rock, AR, CCN 041055 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 30, 1972

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1457054769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1285",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131285",
            "telephone_number": "870-543-2300",
            "fax_number": "870-535-4716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1724 BISHOP ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722026022",
            "telephone_number": "870-543-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "enumeration_date": "2023-03-24",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-543-2380"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Comprehensive Care System, Inc- ABC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.