NPIMap

Organization Active NPI

White River Health System, Inc.

Doing business as Melbourne Medical Clinic

  • Rural Health Clinic/Center
  • Melbourne, AR
National Provider Identifier
1477523348
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
Melbourne Medical Clinic
Practice address
1526 E. Main St.
Melbourne, AR 72556
Phone
(870) 368-4344
Fax
(870) 368-3051
NPI assigned
Jan 24, 2006
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Shawna Baxter
Title
Provider Enrollment
Phone
(870) 262-5545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

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 1

IdentifierTypeStateIssuer
124189729MedicaidAR

Other names 1

  • Melbourne Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477523348. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 24, 1999 in AR
Enrollment address
1526 E Main St
Ste a
Melbourne, AR 72556-9315
Related CCNs
040119

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

View all 16

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0468315Melbourne Medical Clinic1526 East Main Street, Melbourne, AR 72556ComplianceMar 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pleasant Plains Medical48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Crystal Johnson Individual Corporate OfficerSecretary Jan 1, 2026
White River Health System, Inc. Organization, Batesville, AR Non-profit Operational/Managerial Control Oct 16, 2007
Stacy Gunderman Individual Corporate OfficerBoard Member Jan 1, 2026
Maggie Williams Individual Corporate DirectorExecutive Director Jan 1, 2026
Danny Bell Individual Corporate OfficerBoard Member Jan 1, 2026
Robert McIntire Individual Corporate OfficerTreasurer Jan 1, 2026
Elizabeth Christian Individual Corporate OfficerBoard Member Jan 1, 2026
Jason Taylor Individual Corporate OfficerBoard Member Jan 1, 2026
Tina Wheelis Individual Corporate OfficerBoard Member Jan 1, 2026
Shawna Baxter Individual W-2 Managing EmployeeProvider Enrollment Specialist Aug 28, 2023
Kevin S Rose Individual Corporate OfficerBoard Member Jan 1, 2026
Randy Cross Individual Corporate OfficerChairman Jan 1, 2026
Kathy Lanier Individual Corporate OfficerBoard Member Jan 1, 2026
Lisa Lambert Individual Corporate DirectorExecutive Director Jan 1, 2024
William Tyler Fowlkes Individual Corporate OfficerVice-Chairman Jan 1, 2026
Lance Lamberth Individual Corporate OfficerBoard Member Jan 1, 2026

All facility ownership & control disclosures 16

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

FacilityTypeRoleSince
White River Medical CenterBatesville, AR, CCN 040119 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 31, 1976
Jan 31, 1976
Stone County Medical CenterMountain View, AR, CCN 041310 Hospital Operational/Managerial Control Jan 1, 2008
Stone County Medical CenterMountain View, AR, CCN 04Z310 Hospital 5% Or Greater Direct Ownership Interest Apr 1, 1999
White River Medical CenterBatesville, AR, CCN 04S119 Hospital Operational/Managerial Control Dec 21, 2007
White River Medical Center Rehabilitation UnitBatesville, AR, CCN 04T119 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Midway Medical ClinicCherokee Village, AR, CCN 043981 Rural health clinic Operational/Managerial Control (100%) Sep 10, 2010
Drasco Medical ClinicDrasco, AR, CCN 043455 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 1996
Cave City Medical ClinicCave City, AR, CCN 043982 Rural health clinic Operational/Managerial Control Nov 19, 1991
Plesant Plains Medical ClinicPleasant Plains, AR, CCN 043422 Rural health clinic Operational/Managerial Control Jul 1, 2006
White River Health Family CareMountain View, AR, CCN 043884 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2015
Sugarloaf Medical ClinicHeber Springs, AR, CCN 043914 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021
White River Health Family CareNewark, AR, CCN 048540 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family CareBatesville, AR, CCN 048539 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family CareSouthside, AR, CCN 048541 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Care FamilyBatesville, AR, CCN 048542 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023
White River Health Children's ClinicBatesville, AR, CCN 048543 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1477523348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 HARRISON ST",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017303",
            "telephone_number": "870-262-5545",
            "fax_number": "870-262-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 E. MAIN ST.",
            "city": "MELBOURNE",
            "state": "AR",
            "postal_code": "72556",
            "telephone_number": "870-368-4344",
            "fax_number": "870-368-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "870-262-5545"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124189729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Melbourne Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, AR

Sources for this page

Verify at the official NPI Registry.