NPIMap

Organization Active NPI

Bradley Bibb MD PLLC

  • Rural Health Clinic/Center
  • Salem, AR
National Provider Identifier
1568200061
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRADLEY BIBB MD PLLC
Practice address
115 Turner LN
Salem, AR 72576-5600
Phone
(870) 895-3238
NPI assigned
Jul 18, 2024
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Monya York
Title
Controller
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

115 Turner LN
Salem, AR 72576-5600

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002

Other names 1

  • Access Medical Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100628000488 AR Part B Supplier - Clinic/Group Practice 4789715285 Receives reassigned benefits from 95 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ash Flat, AR; Black Rock, AR; Bono, AR; Dardanelle, AR; Hardy, AR; Marked Tree, AR; Salem, AR; Texarkana, AR
O20240816001027 AR Part A Provider - Rural Health Clinic 4789715285 Practice locations: Salem, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568200061. Details of each certification follow.

Rural health clinic certification: CCN 043955

Legal name
BRADLEY BIBB MD PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 29, 2024
Last certification
Dec 29, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jul 23, 2008 in AR
Enrollment address
115 Turner LN
Salem, AR 72576-5600

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 10

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
04D2308339Bradley Bibb, MD PLLC115 Turner Lane, Salem, AR 72576Certificate of waiverJul 24, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Mark Hahn Individual 5% Or Greater Direct Ownership InterestMedical Director May 8, 2025 100%
Corporate OfficerMedical Director May 8, 2025
Jared Clifford Individual Corporate OfficerPresident May 8, 2025
Sheri N Davis Individual W-2 Managing EmployeeVP of Provider Mgmnt May 8, 2025
Monya York Individual W-2 Managing EmployeeDirector Credentialing May 8, 2025
Operational/Managerial ControlDirector Credentialing May 8, 2025
Randi L Davis Individual W-2 Managing EmployeeDirector Provider Mgmnt May 8, 2025
Candice M Cartwright Individual W-2 Managing EmployeeClinic Director May 8, 2025

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1721260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1568200061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 TURNER LN",
            "city": "SALEM",
            "state": "AR",
            "postal_code": "725765600",
            "telephone_number": "870-895-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY BIBB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-18",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Access Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salem, AR

Sources for this page

Verify at the official NPI Registry.