NPIMap

Organization Active NPI

Mainline Health Systems, Inc

Doing business as Dermott School Clinic

  • Federally Qualified Health Center (FQHC)
  • Dermott, AR
National Provider Identifier
1477004471
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MAINLINE HEALTH SYSTEMS, INC
Doing business as
Dermott School Clinic
Practice address
525 E Speedway St
Dermott, AR 71638-2322
Phone
(870) 277-2658
Fax
(855) 811-4203
NPI assigned
Oct 14, 2016
Last updated
Mar 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Authorized official

Name
Gary Allan Nichols
Title
Ceo
Phone
(870) 942-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

525 E Speedway St
Dermott, AR 71638-2322

Mailing address

342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000

Other names 1

  • Dermott School Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170201000335 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193785590 Practice locations: Dermott, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477004471. Details of each certification follow.

Federally qualified health center certification: CCN 041922

Legal name
MAINLINE HEALTH SYSTEMS INC
Doing business as
DERMOTT SCHOOL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 27, 2016
Last certification
Dec 27, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1978 in AR
Enrollment address
525 E Speedway St
Dermott, AR 71638-2322

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Gary Nichols Individual Corporate DirectorExecutive Director Sep 1, 2009
W-2 Managing EmployeeCeo Sep 1, 2009
Ron Miller Individual Corporate DirectorBoard Member Jan 1, 2008
Robert Thomas Individual Corporate DirectorBoard Member Jan 1, 1996
Brandi Poole Individual Corporate OfficerExecutive Board Recruitment Chair Jan 1, 2018
Alicia Whitaker Individual Corporate OfficerChairman Executive Jan 1, 2018
Mainline Health Systems Inc Organization, Dermott, AR Corporation, Non-profit Operational/Managerial Control Aug 17, 2016 100%
Mary Hollins Scott Individual Corporate DirectorBoard Member Jan 1, 1996
Keith Shepherd Individual Corporate DirectorBoard Member Jan 1, 2015
Eugene Butler Individual Corporate DirectorBoard Member Jan 1, 2012
Becky Philips Individual Corporate OfficerTreasurer Finance Chair Executive Jan 1, 2019
Elyse Knobloch Individual Operational/Managerial ControlChief Financial Officer Aug 14, 2023
Michelle Dunbar Individual Corporate DirectorBoard Member Jan 1, 2012
Shanna Knowles Individual Corporate OfficerPersonnel Finance Jan 1, 2020

All facility ownership & control disclosures 25

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

FacilityTypeRoleSince
Monticello Community Health CenterMonticello, AR, CCN 041875 Federally qualified health center Operational/Managerial Control Jul 1, 2010
Portland Elementary ClinicPortland, AR, CCN 041917 Federally qualified health center Operational/Managerial Control (100%) Jan 11, 2016
Hamburg ElementartyHamburg, AR, CCN 041918 Federally qualified health center Operational/Managerial Control (100%) Jan 11, 2016
Mainline Health Systems IncHamburg, AR, CCN 041919 Federally qualified health center Operational/Managerial Control (100%) Jan 11, 2016
Star City Community Health CenterStar City, AR, CCN 041921 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2013
Star City High School ClinicStar City, AR, CCN 041923 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2017
Jimmy Brown ElementaryStar City, AR, CCN 041926 Federally qualified health center Operational/Managerial Control (100%) Apr 4, 2017
Eudora Elementary ClinicEudora, AR, CCN 041933 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2017
Drew Central SchoolMonticello, AR, CCN 041935 Federally qualified health center Operational/Managerial Control (100%) Aug 14, 2017
Lakeside SchoolLake Village, AR, CCN 041934 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2017
Hamburg Middle SchoolHamburg, AR, CCN 041945 Federally qualified health center Operational/Managerial Control (100%) Sep 20, 2018
Mainline Health Systems IncRison, AR, CCN 041953 Federally qualified health center Operational/Managerial Control (100%) Dec 26, 2018
Warren 2Warren, AR, CCN 041966 Federally qualified health center Operational/Managerial Control (100%) Jan 2, 2020
Mainline Health Systems IncMonticello, AR, CCN 041005 Federally qualified health center 5% Or Greater Direct Ownership Interest
5% Or Greater Security Interest
Operational/Managerial Control		 Oct 1, 2021
Oct 1, 2021
Oct 1, 2021
Mainline Uam Medical ClinicMonticello, AR, CCN 041006 Federally qualified health center 5% Or Greater Direct Ownership Interest
5% Or Greater Security Interest
Operational/Managerial Control		 Oct 1, 2021
Oct 1, 2021
Oct 1, 2021
Sheridan SchoolSheridan, AR, CCN 041008 Federally qualified health center 5% Or Greater Direct Ownership Interest
5% Or Greater Security Interest
Operational/Managerial Control		 Apr 1, 2022
Apr 1, 2022
Apr 1, 2022
Sheridan Medical ClinicSheridan, AR, CCN 041009 Federally qualified health center 5% Or Greater Direct Ownership Interest
5% Or Greater Security Interest
Operational/Managerial Control		 Apr 1, 2022
Apr 1, 2022
Apr 1, 2022
Warren Middle School BHWarren, AR, CCN 041013 Federally qualified health center 5% Or Greater Direct Ownership Interest
5% Or Greater Security Interest
Operational/Managerial Control		 Jul 13, 2022
Jul 13, 2022
Jul 13, 2022
Warren High School BH (Seabec)Warren, AR, CCN 041019 Federally qualified health center Operational/Managerial Control Aug 15, 2022
Mainline Health Systems IncWarren, AR, CCN 041025 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 15, 2022
Aug 15, 2022
Brunson Elementary SchoolWarren, AR, CCN 041015 Federally qualified health center 5% Or Greater Direct Ownership Interest
5% Or Greater Security Interest
Operational/Managerial Control		 Jul 13, 2022
Jul 13, 2022
Jul 13, 2022
Sheridan East EndLittle Rock, AR, CCN 041023 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Aug 15, 2022
Aug 15, 2022
Warren ElementaryWarren, AR, CCN 041033 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 26, 2023
Jun 26, 2023
Lake Village OB ClinicLake Village, AR, CCN 041047 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 3, 2023
Jul 3, 2023
Cleveland County School District Health CenterRison, AR, CCN 041084 Federally qualified health center Operational/Managerial Control (100%) Aug 14, 2017

Facilities with the same owner 25

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

View all 25

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1476403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773964800000",
    "number": "1477004471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 HIGHWAY 425 S",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554612",
            "telephone_number": "870-942-3000",
            "fax_number": "870-942-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E SPEEDWAY ST",
            "city": "DERMOTT",
            "state": "AR",
            "postal_code": "716382322",
            "telephone_number": "870-277-2658",
            "fax_number": "855-811-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-14",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-942-3000"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermott School Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermott School Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dermott, AR

Sources for this page

Verify at the official NPI Registry.