White River Health System, Inc.
Organization Active NPI Rural Health Clinic/Center · Melbourne, AR
NPI 1477523348 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1477523348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- WHITE RIVER HEALTH SYSTEM, INC.
- Practice address
- 1526 E. Main St.
Melbourne, AR 72556 - Phone
- (870) 368-4344
- Fax
- (870) 368-3051
- NPI assigned
- Jan 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Shawna Baxter
- Title
- Provider Enrollment
- Phone
- (870) 262-5545
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 47
Related certifications (CCN) 16
Facilities with the same owner 16
Practitioners 63
-
Jana Allen, CRNA
-
Elizabeth Divina Anderson, CRNA, DNP
-
Suzanna C Blackburn, APN
-
Jennifer Blaney, NP
-
Gale Brantley, CRNA
-
James R Bridgeman, APRN
-
Terry L Burns, MD
-
Steven Clay Chaffin, CRNA
-
Kayla Krystyna Crawford, APRN
-
Andy Davidson, MD
-
Blaine C Dore', CRNA
-
Laura B Dover, CRNA
-
Jarrod Scott Duke, CRNA
-
Zelda R. Epperson-May, CRNA
-
Melinda Ford, APRN
-
Tia Ellen Franklin, CRNA
-
Billie Ann Gay, CRNA, DNP
-
Duane Gill, CRNA
-
Cindy E Hall, CRNA
-
Birtha V Hartness, ANP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D0468315 | Melbourne Medical Clinic | Compliance | Mar 12, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Rural health clinic certification: CCN 043997
- Legal name
- WHITE RIVER HEALTH SYSTEM, INC.
- Doing business as
- MELBOURNE MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 29, 1993
- Last certification
- Nov 20, 2015
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 24, 1999 in AR
- Enrollment address
- 1526 E Main St
Ste a
Melbourne, AR 72556-9315 - Related CCNs
- 040119
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Crystal Johnson |
Corporate Officer |
Jan 1, 2026 | |
| White River Health System, Inc. |
Operational/Managerial Control | Oct 16, 2007 | |
| Stacy Gunderman |
Corporate Officer |
Jan 1, 2026 | |
| Maggie Williams |
Corporate Director |
Jan 1, 2026 | |
| Danny Bell |
Corporate Officer |
Jan 1, 2026 | |
| Robert McIntire |
Corporate Officer |
Jan 1, 2026 | |
| Elizabeth Christian |
Corporate Officer |
Jan 1, 2026 | |
| Jason Taylor |
Corporate Officer |
Jan 1, 2026 | |
| Tina Wheelis |
Corporate Officer |
Jan 1, 2026 | |
| Shawna Baxter |
W-2 Managing Employee |
Aug 28, 2023 | |
| Kevin S Rose |
Corporate Officer |
Jan 1, 2026 | |
| Randy Cross |
Corporate Officer |
Jan 1, 2026 | |
| Kathy Lanier |
Corporate Officer |
Jan 1, 2026 | |
| Lisa Lambert |
Corporate Director |
Jan 1, 2024 | |
| William Tyler Fowlkes |
Corporate Officer |
Jan 1, 2026 | |
| Lance Lamberth |
Corporate Officer |
Jan 1, 2026 |
All facility ownership & control disclosures 16
| Facility | Type | Role | Since |
|---|---|---|---|
| White River Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 31, 1976 Jan 31, 1976 |
| Stone County Medical Center |
Hospital | Operational/Managerial Control | Jan 1, 2008 |
| Stone County Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest | Apr 1, 1999 |
| White River Medical Center |
Hospital | Operational/Managerial Control | Dec 21, 2007 |
| White River Medical Center Rehabilitation Unit |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1976 |
| Midway Medical Clinic |
Rural health clinic | Operational/Managerial Control (100%) | Sep 10, 2010 |
| Drasco Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 12, 1996 |
| Cave City Medical Clinic |
Rural health clinic | Operational/Managerial Control | Nov 19, 1991 |
| Plesant Plains Medical Clinic |
Rural health clinic | Operational/Managerial Control | Jul 1, 2006 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2015 |
| Sugarloaf Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2021 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| White River Health Family Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| White River Health Care Family |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2023 |
| White River Health Children'S Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071205000040 | AR | Part a Provider - Rural Health Clinic | 0143134270 | Practice locations: Melbourne, AR |
| O20110510000339 | AR | Part B Supplier - Clinic/Group Practice | 0143134270 |
Receives reassigned benefits from 58 practitioners 2 other NPIs on this enrollment Practice locations: Batesville, AR; Melbourne, AR; Mountain View, AR |
National Provider Directory
- Tax ID family
- White Riv HLTH Syst Inc
Locations
1526 E Main St
Melbourne, AR 72556
Phone (870) 262-3210
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1526 E. Main St.
Melbourne, AR 72556
Mailing address
1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 262-5545
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124189729 | Medicaid | AR |
Other names
- Melbourne Medical Clinic
Other providers in Melbourne, AR
- Twin Lakes Therapy & Living Center, Inc.
- James Walls
- Tiffany Ann Webb
- Vicki Lynne Webb
- Lacey Leann Weston
- Sonya Hames Wiles
- Lacy Williams
- Kaylee Woodall
- Worthy Endeavors PLLC
- Doyle Harrison Wyatt
All providers in Melbourne, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.