NPIMap

Organization Active NPI

Kidspiration Behavioral Health

  • Developmental - Behavioral Pediatrics Physician
  • Mountain Home, AR
National Provider Identifier
1558908780
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
KIDSPIRATION BEHAVIORAL HEALTH
Doing business as
Kidspiration Behavioral Health
Practice address
1310 Bradley Dr
Mountain Home, AR 72653-2730
Phone
(870) 424-4021
Fax
(870) 424-4112
NPI assigned
Dec 6, 2019
Last updated
Dec 6, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
KIDSPIRATION OUTPATIENT THERAPY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Authorized official

Name
Jolene Shockey
Title
Billing Manager
Phone
(870) 424-4021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X Primary

Addresses

Primary practice location

1310 Bradley Dr
Mountain Home, AR 72653-2730

Mailing address

PO Box 2533
Mountain Home, AR 72654-2533
Phone (870) 424-4021

Other names 1

  • Kidspiration Behavioral Health Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address joleneshockey@kidsmh.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Kids El Melbourne4 organizations share this tax ID, including this one
Part of
Kids El Melbourne

Other organizations with this tax ID 3

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1558908780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2533",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726542533",
            "telephone_number": "870-424-4021",
            "fax_number": "870-424-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 BRADLEY DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532730",
            "telephone_number": "870-424-4021",
            "fax_number": "870-424-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSPIRATION BEHAVIORAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDSPIRATION OUTPATIENT THERAPY SERVICES",
        "enumeration_date": "2019-12-06",
        "last_updated": "2019-12-06",
        "status": "A",
        "authorized_official_last_name": "SHOCKEY",
        "authorized_official_first_name": "JOLENE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "870-424-4021"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "joleneshockey@kidsmh.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1310 Bradley Dr",
            "city": "Mountain Home",
            "state": "AR",
            "country_code": "US",
            "postal_code": "726532730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kidspiration Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.