NPIMap

Organization Active NPI

Pocahontas Medical Clinic PA

  • Family Medicine Physician
  • Pocahontas, AR
National Provider Identifier
1508855305
Registry record updated Jun 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
POCAHONTAS MEDICAL CLINIC PA
Practice address
2901 Medical Center Dr
Pocahontas, AR 72455-9438
Phone
(870) 892-4467
Fax
(870) 892-4407
NPI assigned
Oct 14, 2005
Last updated
Jun 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2010

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

Authorized official

Name
Dr. Brent E Holt, MDNPI 1053300558
Title
Physician Owner
Phone
(870) 892-4467

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2901 Medical Center Dr
Pocahontas, AR 72455-9438

Mailing address

2901 Medical Center Dr
Pocahontas, AR 72455-9438
Phone (870) 892-4467

Other identifiers 2

IdentifierTypeStateIssuer
139208002MedicaidAR
160097729MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000397 AR Part B Supplier - Clinic/Group Practice 4688651029 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
Practice locations: Corning, AR; Pocahontas, AR

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
04D0468136Pocahontas Medical Clinic P a2901 Medical Center Drive, Suite 500, Pocahontas, AR 72455ComplianceDec 26, 2027

National Provider Directory

National Provider Directory

Locations

2901 Medical Center Dr
Pocahontas, AR 72455
Phone (870) 892-4467

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276819200000",
    "number": "1508855305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 MEDICAL CENTER DR",
            "city": "POCAHONTAS",
            "state": "AR",
            "postal_code": "724559438",
            "telephone_number": "870-892-4467",
            "fax_number": "870-892-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 MEDICAL CENTER DR",
            "city": "POCAHONTAS",
            "state": "AR",
            "postal_code": "724559438",
            "telephone_number": "870-892-4467",
            "fax_number": "870-892-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCAHONTAS MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2010-06-18",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "870-892-4467",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139208002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160097729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocahontas, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.