NPIMap

Organization Active NPI

Lawrence Memorial Health Foundation Inc.

Doing business as Family Medical Center

  • Rural Health Clinic/Center
  • Walnut Ridge, AR
National Provider Identifier
1528052107
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAWRENCE MEMORIAL HEALTH FOUNDATION INC.
Doing business as
Family Medical Center
Practice address
1309 W Main St
Walnut Ridge, AR 72476-1430
Phone
(870) 886-3211
Fax
(870) 886-9027
NPI assigned
Sep 9, 2005
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Mrs. Vanessa K Wagner
Title
Cfo
Phone
(870) 886-1263

Specialties & licenses 1

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

Addresses

Primary practice location

1309 W Main St
Walnut Ridge, AR 72476-1430

Mailing address

PO Box 839
Walnut Ridge, AR 72476-0839
Phone (870) 886-3211

Other names 1

  • Family Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address FamMed@lmh.hin.us Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190319000671 AR Part A Provider - Rural Health Clinic 9436305836 Practice locations: Walnut Ridge, AR
O20191029002135 AR Part B Supplier - Clinic/Group Practice 9436305836 Receives reassigned benefits from 15 practitioners
Practice locations: Walnut Ridge, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528052107. Details of each certification follow.

Rural health clinic certification: CCN 043479

Legal name
LAWRENCE MEMORIAL HEALTH FOUNDATION INC
Doing business as
FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 16, 1998
Last certification
Nov 28, 2018
Ownership / control type
2A
Most recent change of ownership
Jan 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 23, 1998 in AR
Enrollment address
1309 W Main Street
Walnut Ridge, AR 72476-1430
Related CCNs
041309

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Lawrence Mem HLTH FNDT Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Interoperability endpoints

  • Direct secure messaging: fammed@lmh.hin.us

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
William F Wilcoxson Individual Corporate DirectorBoard Member Jun 1, 2015
John H Thomison Individual Corporate DirectorBoard of Directors Jan 1, 2022
Ashley Burris Individual Corporate DirectorBoard of Director Oct 21, 2024
Sebastian a Spades Individual Corporate DirectorBoard Member Jul 1, 1994
Jeff Yates Individual Corporate DirectorBoard of Governors Jun 17, 2024
Bonita a Staudt Individual Corporate DirectorBoard Member Jan 1, 2010
Gregory P McElhanon Individual Corporate DirectorCfo Apr 1, 2023
W-2 Managing EmployeeCfo Apr 1, 2023
James Blake Perkins Individual Corporate DirectorBoard Member Jan 1, 2017
Jeremy Hopper Individual Corporate DirectorBoard of Directors Dec 1, 2023
Rhonda Forrester Individual Corporate DirectorBoard Member Dec 1, 2018
Aaron Andrews Individual Corporate DirectorBoard of Directors Sep 1, 2021
Wilma M Jones Individual Corporate DirectorBoard Member May 1, 2017
Lila J Floyd Individual Corporate DirectorBoard Member Jul 1, 2004
Kerry Dalton Individual Corporate DirectorBoard Member Dec 1, 2018

Owners & managing parties with NPI records 1

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

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2019 Change of OwnershipThis provider was the buyer Family Medical CenterCCN 043479, AR, NPI 1528052107
Jan 1, 2019 Change of OwnershipThis provider was the seller Family Medical CenterCCN 043479, AR, NPI 1528052107

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1528052107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 839",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724760839",
            "telephone_number": "870-886-3211",
            "fax_number": "870-886-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761430",
            "telephone_number": "870-886-3211",
            "fax_number": "870-886-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE MEMORIAL HEALTH FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-886-1263",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "FamMed@lmh.hin.us",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1309 W Main St",
            "city": "Walnut Ridge",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724761430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Ridge, AR

Sources for this page

Verify at the official NPI Registry.