NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Huntsville, AR
National Provider Identifier
1467543892
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC
Practice address
934 N Gaskill St
Huntsville, AR 72740-8903
Phone
(479) 738-5500
Fax
(479) 738-1350
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

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

Addresses

Primary practice location

934 N Gaskill St
Huntsville, AR 72740-8903

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5101

Other identifiers 3

IdentifierTypeStateIssuer
149029749MedicaidAR
5B477OtherARBLUE CROSS OF ARKANSAS GR
DA1111OtherARRAILROAD MEDICARE PIN GRO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030110000006 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Huntsville, AR
O20040701000737 AR Part B Supplier - Clinic/Group Practice 3870401722 Receives reassigned benefits from 58 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…

Federally qualified health center certification: CCN 041848

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 7, 2003
Last certification
Jan 7, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 21, 1992 in AR
Enrollment address
934 N. Gaskill St.
Huntsville, AR 72740-2740
Related CCNs
041833

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Boston Mountain Rural Health Center Inc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
James Arnold Individual Corporate OfficerBoard Member Oct 8, 2013
Mary Lynn Emmett Individual Corporate OfficerBoard Member Aug 3, 2010
Charles Reece Individual Corporate OfficerBoard Member Mar 1, 2012
Christopher Graham Individual Corporate OfficerBoard Member Oct 8, 2013
David Doshier Individual Corporate OfficerBoard Member Feb 1, 2012
Graciela Reynolds Individual Corporate DirectorBoard Member Jan 10, 2003
Donna Samples Individual Corporate DirectorVice Chariman Jan 10, 2003
Rebecca Blair Individual Corporate OfficerCfo Dec 16, 2013
W-2 Managing Employee Dec 16, 2013
Danny Horton Individual Corporate OfficerBoard Member Feb 1, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1467543892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 N GASKILL ST",
            "city": "HUNTSVILLE",
            "state": "AR",
            "postal_code": "727408903",
            "telephone_number": "479-738-5500",
            "fax_number": "479-738-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149029749",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ARKANSAS GR",
            "identifier": "5B477",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN GRO",
            "identifier": "DA1111",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AR

Sources for this page

Verify at the official NPI Registry.