NPIMap

Organization Active NPI

Washington Regional Medical Center

Doing business as Washington Regional Home Health

  • Home Health Agency
  • Fayetteville, AR
National Provider Identifier
1497956213
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
AR4138 Issued in AR
Legal business name
WASHINGTON REGIONAL MEDICAL CENTER
Doing business as
Washington Regional Home Health
Practice address
2863 N Quality Lane
Fayetteville, AR 72703-5521
Phone
(479) 463-7384
Fax
(479) 442-2867
NPI assigned
May 30, 2007
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
WASHINGTON REGIONAL HOME HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Mr. Dan R Eckels
Title
SVP & Cfo
Phone
(479) 463-6026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X AR4138 AR Primary

Addresses

Primary practice location

2863 N Quality Lane
Fayetteville, AR 72703-5521

Mailing address

2863 N Quality Lane
Fayetteville, AR 72703-5521
Phone (479) 463-7384

Other identifiers 2

IdentifierTypeStateIssuer
114474514MedicaidAR
17102OtherARBLUE CROSS PROVIDER

Other names 1

  • Washington Regional Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225000487 AR Part A Provider - Home Health Agency 7214844034 Practice locations: Fayetteville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497956213. Details of each certification follow.

Home health agency certification: CCN 047102

Legal name
WASHINGTON REGIONAL MEDICAL CENTER
Doing business as
WASHINGTON REGIONAL MEDICAL CENTER HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 11, 1988
Last certification
Nov 16, 2018
Ownership / control type
Non-Profit
Organization structure
OtherNon-profit
Incorporated
May 18, 1988 in AR
Enrollment address
2683 N Quality LN
Fayetteville, AR 72703-5521

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Washington Regional Home HealthCCN 047102 · All quality measures
Overall star rating
2.5 of 5
Ownership
Non-Profit
Certified
Feb 11, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Washington Reg Med Cent5 organizations share this tax ID, including this one
Part of
Washington Reg Med Cent

Other organizations with this tax ID 4

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

Member organizations 7

Organizations listed as members of this organization in the National Provider Directory.

Locations

2683 N Quality Ln
Fayetteville, AR 72703
Phone (479) 463-1840

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
Jon Michael Berry Individual Corporate DirectorBoard Member Jan 1, 2022
M Gareth Eck Individual Corporate DirectorBoard Member Jan 1, 2007
Thomas Olmstead Individual Corporate OfficerSr. Vice President/General Counsel Jan 18, 2005
Karen McIntosh Individual W-2 Managing Employee Sep 1, 2017
Stacey Hanby Individual Corporate DirectorBoard Member Jan 1, 2009
Marshall Saviers Individual Corporate DirectorBoard Member Jan 1, 2023
James L Shackelford Individual Corporate OfficerPresident and Chief Executive of Sep 1, 2017 100%
W-2 Managing Employee Sep 1, 2017
Anne O'Leary-Kelly Individual Corporate DirectorBoard Member Jan 1, 2022
Dennis Charles Burrows Individual Corporate OfficerChief Accounting Officer Mar 1, 2023
David Grady Ratcliff Individual Corporate OfficerChief Medical Officer Jan 17, 2006
Greg Lee Individual Corporate DirectorBoard Member Jan 1, 2010
Nancy Mitchell Individual W-2 Managing EmployeeDelegated Official Mar 21, 2019
Birch Wright Individual Corporate OfficerCoo & Administrator Aug 1, 2020
Neal Pendergraft Individual Corporate DirectorBoard Member Jan 1, 2018
George Gearhart Individual Corporate DirectorBoard Member Jan 1, 2022
Lucas K Campbell Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Encompass Health Rehabilitation Hospital, a Partner of Washington RegiFayetteville, AR, CCN 043032 Hospital 5% Or Greater Indirect Ownership Interest (50%) Dec 31, 2007

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 1

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.

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1497956213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2863 N QUALITY LANE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035521",
            "telephone_number": "479-463-7384",
            "fax_number": "479-442-2867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2863 N QUALITY LANE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035521",
            "telephone_number": "479-463-7384",
            "fax_number": "479-442-2867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WASHINGTON REGIONAL HOME HEALTH",
        "enumeration_date": "2007-05-30",
        "last_updated": "2021-04-15",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SVP & CFO",
        "authorized_official_telephone_number": "479-463-6026",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AR",
            "license": "AR4138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114474514",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS  PROVIDER",
            "identifier": "17102",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Regional Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Washington Regional Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.