Bradley Bibb MD PLLC
Organization Active NPI Rural Health Clinic/Center · Salem, AR
NPI 1568200061 · NPPES record last updated Jan 23, 2025
Key facts
- NPI
- 1568200061
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Monya York
- Title
- Controller
- Phone
- (870) 856-1202
Owners & managing parties with NPI records 4
-
Randi L Davis, APRN
-
Sheri N. Davis, A.P.R.N., FNP-C
-
Mark S Hahn, DO
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 12
Practitioners 74
-
Bradley Ray Bibb, MD
-
Courtney Linn Cavender, APRN
-
Terri N Moody, APN
-
Samuel Allen Nix, FNP
-
Brandy N Anderson, APRN
-
Kirsten Baker, PA-C
-
Jody A Barham, APN
-
Shannon Black, FNP-BC
-
Courtney Brashear, APRN
-
James Ryan Carroll, APRN
-
Rebecca Coble, APRN, FNP-C
-
Katie Rae Crawford, PA-C
-
Gerrica Davidson, NP
-
Stephanie Eagle, FNP-BC
-
Leigh Ann Ellis, DNP
-
Lacey Head Farrar, MSN, AG-ACNP, FNP
-
Linzy Gavin, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2308339 | Bradley Bibb, MD PLLC | Certificate of waiver | Jul 24, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
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
- LLC · Proprietary
- Incorporated
- Jul 23, 2008 in AR
- Enrollment address
- 115 Turner LN
Salem, AR 72576-5600
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Hahn |
5% Or Greater Direct Ownership Interest |
May 8, 2025 | 100% |
| Corporate Officer |
May 8, 2025 | ||
| Jared Clifford |
Corporate Officer |
May 8, 2025 | |
| Sheri N Davis |
W-2 Managing Employee |
May 8, 2025 | |
| Monya York |
W-2 Managing Employee |
May 8, 2025 | |
| Operational/Managerial Control |
May 8, 2025 | ||
| Randi L Davis |
W-2 Managing Employee |
May 8, 2025 | |
| Candice M Cartwright |
W-2 Managing Employee |
May 8, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Access Medical Clinic
Other providers in Salem, AR
- Baxter Health Fulton County Hospital
- Baxter Health Fulton County Hospital
- Baxter Health Fulton County Hospital
- Bokker Enterprises, Inc.
- Jimmy G Bozeman
- Connie F. Bray
- Patsy Louise Britt
- BRMC Clinic at Salem, Arkansas
- Angie Cadenbach
- Audrey Renee Crowl
All providers in Salem, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.