Jefferson Comprehensive Care System, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Little Rock, AR
NPI 1457054769 · NPPES record last updated Mar 24, 2023
Key facts
- NPI
- 1457054769
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- Yes
- Parent organization (as reported)
- JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Authorized official
- Name
- Sandra J. Brown
- Title
- Ceo
- Phone
- (870) 543-2380
Owners & managing parties with NPI records 9
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 8
Facilities with the same owner 1
Practitioners 21
-
Pauline Okwuosa, NURSE PRACTITIONER
-
April Michele Rainbolt, APRN
-
Linda G Cabine, A.N.P.
-
Carla Devose, APRN
-
Martha Victoria Hobson, APRN
-
Yolanda Jeffery, APRN
-
Manuel R Kelley, M.D.
-
Crystal Rochelle Holmes, APRN
-
Lenreyah Moore, APRN
-
Vunkisha Nash, FNP-BC
-
Shanna Rahmaan, CNP
-
Christy Nicole Reed, APRN
-
Uhronda Reel, APRN
-
Lina Nasr-Anaissie, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
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
- Corporation · Non-profit
- Incorporated
- Apr 15, 2023 in AR
- Enrollment address
- 1724 Bishop St
Little Rock, AR 72202-6022
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Monica Williams |
Corporate Officer | Mar 1, 2023 | |
| Lillie Reeves |
Corporate Officer |
Mar 1, 2023 | |
| Eduardo R. Ochoa |
Corporate Officer |
Mar 1, 2023 | |
| Bonita Corbin |
Corporate Officer | Mar 1, 2023 | |
| Cheryl Broughton |
Corporate Officer |
Mar 1, 2023 | |
| Edward Davis |
Corporate Officer | Mar 1, 2023 | |
| Chanda Evans-McField |
Corporate Director |
Feb 1, 2010 | |
| W-2 Managing Employee | Feb 2, 2010 | ||
| Sandra J Brown |
Corporate Director |
Feb 2, 2009 | |
| Jefferson Comprehensive Care System, Inc |
5% Or Greater Direct Ownership Interest | Nov 30, 1972 | |
| Zackery Tallaferro |
Corporate Officer | Mar 1, 2023 | |
| William Burney |
Corporate Officer |
Mar 1, 2023 | |
| Jerry Malone |
Corporate Officer | Mar 1, 2023 | |
| Linzie Anderson |
Corporate Officer | Mar 1, 2023 | |
| Marie Lindquist |
Corporate Officer | Mar 1, 2023 | |
| Earnestine Daniels |
Corporate Officer |
Mar 1, 2023 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Downtown Little Rock Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Nov 30, 1972 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240315000690 | AR | Part a Provider - Federally Qualified Health Center (FQHC) | 5193634509 | Practice locations: Little Rock, AR |
National Provider Directory
- Part of
- Pine Bluff Health Clinic
Locations
309 S Edline
Altheimer, AR 72004
Phone (870) 543-2380
1522 W 10th St
Little Rock, AR 72202
Phone (501) 376-1295
3000 Springer Blvd
Little Rock, AR 72206
Phone (870) 536-5576
1225 Martin Luther King Dr
Little Rock, AR 72202
Phone (501) 244-2121
3000 Springer Blvd
Ste B
Little Rock, AR 72206
Phone (501) 244-2121
2525 Willow St
North Little Rock, AR 72114
Phone (501) 812-0225
1101 S Tennessee St
Pine Bluff, AR 71601
Phone (870) 543-2300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Jefferson Comprehensive Care System, Inc- ABC
Other providers in Little Rock, AR
- Kaitlyn Michelle Jeffcoat
- Robin Jeffers Perry
- Charles Darwin Jeffers
- Teresa Renee Jeffers
- Jefferson Comprehensive Care System, Inc
- Jefferson Comprehensive Care System, Inc
- Jefferson Comprehensive Care System, Inc
- Akilah Andrea Jefferson
- Antarika Jefferson
- Carolyn Alina Jefferson
All providers in Little Rock, AR · Federally Qualified Health Center (FQHC) in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.