NPIMap

Organization Active NPI

Jefferson Comprehensive Care System, Inc

  • Federally Qualified Health Center (FQHC)
  • Little Rock, AR
National Provider Identifier
1548031016
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Practice address
1400 Main St
Little Rock, AR 72202-5036
Phone
(870) 543-2300
Fax
(870) 535-4716
NPI assigned
Jan 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Chanda Evans McField
Title
Cfo/Cao
Phone
(870) 543-2380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1400 Main St
Little Rock, AR 72202-5036

Mailing address

PO Box 1285
Pine Bluff, AR 71613-1285
Phone (870) 543-2311

Other names 1

  • Downtown Little Rock Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240228000867 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193634509 Practice locations: Little Rock, AR

Federally qualified health center certification: CCN 041055

Legal name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Doing business as
DOWNTOWN LITTLE ROCK COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 19, 2024
Last certification
Feb 19, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2024 in AR
Enrollment address
1400 Main St
Little Rock, AR 72202-5036

Other NPIs with the same Medicare PAC ID 8

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

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
04D2296709Downtown Little Rock Community Health Ctr1400 Main Street, Little Rock, AR 72202Provider-performed microscopyJan 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pine Bluff Health Clinic12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Monica Williams Individual Corporate Officer Mar 1, 2023
Lillie Reeves Individual Corporate Officer Mar 1, 2023
Eduardo R. Ochoa Individual Corporate Officer Mar 1, 2023
Bonita Corbin Individual Corporate Officer Mar 1, 2023
Cheryl Broughton Individual Corporate Officer Mar 1, 2023
Edward Davis Individual Corporate Officer Mar 1, 2023
Chanda Evans-McField Individual Corporate DirectorCfo/Cao Feb 1, 2010
W-2 Managing EmployeeCfo/Cao Feb 1, 2010
Sandra J Brown Individual Corporate DirectorCeo Feb 2, 2009
W-2 Managing EmployeeCeo Feb 2, 2009 100%
Jefferson Comprehensive Care System, Inc Organization, Pine Bluff, AR Medical provider/supplier, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Nov 30, 1972
Zackery Tallaferro Individual Corporate Officer Mar 1, 2023
William Burney Individual Corporate Officer Mar 1, 2009
Jerry Malone Individual Corporate Officer Mar 1, 2023
Linzie Anderson Individual Corporate Officer Mar 1, 2023
Marie Lindquist Individual Corporate Officer Mar 1, 2023
Earnestine Daniels Individual Corporate Officer Mar 1, 2023

Owners & managing parties with NPI records 9

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
Jefferson Comprehensive Care System, IncLittle Rock, AR, CCN 041051 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 30, 1972

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1548031016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1285",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131285",
            "telephone_number": "870-543-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722025036",
            "telephone_number": "870-543-2300",
            "fax_number": "870-535-4716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMPREHENSIVE CARE SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "EVANS MCFIELD",
        "authorized_official_first_name": "CHANDA",
        "authorized_official_title_or_position": "CFO/CAO",
        "authorized_official_telephone_number": "870-543-2380"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Downtown Little Rock Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.