NPIMap

Organization Active NPI

White River Health System, Inc.

Doing business as Midway Medical Clinic

  • Rural Health Clinic/Center
  • Cherokee Village, AR
National Provider Identifier
1568432144
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
Midway Medical Clinic
Practice address
195 Hospital Dr
Cherokee Village, AR 72529-7314
Phone
(870) 257-6060
Fax
(870) 257-7667
NPI assigned
Jan 25, 2006
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Shawna Baxter
Title
Provider Enrollment
Phone
(870) 262-5545

Specialties & licenses 1

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

Addresses

Primary practice location

195 Hospital Dr
Cherokee Village, AR 72529-7314

Mailing address

1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 257-6060

Other identifiers 1

IdentifierTypeStateIssuer
120685729MedicaidAR

Other names 1

  • Midway Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040830000837 AR Part B Supplier - Clinic/Group Practice 0143134270 Receives reassigned benefits from 46 practitioners
Practice locations: Cherokee Village, AR
O20071203000287 AR Part A Provider - Rural Health Clinic 0143134270 Practice locations: Cherokee Village, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568432144. Details of each certification follow.

Rural health clinic certification: CCN 043981

Legal name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
MIDWAY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 18, 1991
Last certification
May 18, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 25, 1967 in AR
Enrollment address
195 Hospital Dr
Cherokee Village, AR 72529-7314
Related CCNs
040119

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

View all 16

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
04D0673171Midway Medical Clinic195 Hospital Drive, Suite B, Cherokee Village, AR 72529Certificate of waiverMay 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pleasant Plains Medical48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

195 Hospital Dr
Ste D
Cherokee Village, AR 72529
Phone (870) 257-6040

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Crystal Johnson Individual Corporate OfficerBoard Member Jan 1, 2024
White River Health System, Inc. Organization, Batesville, AR Corporation Operational/Managerial Control Sep 10, 2010 100%
Steve Case Individual Corporate OfficerBoard Member Jan 1, 2024
Rick Elumbaugh Individual Corporate OfficerBoard Member Jan 1, 2024
Paula Terrell Individual Corporate OfficerBoard Member Jan 1, 2024
Robert McIntire Individual Corporate OfficerBoard Member Jan 1, 2024
Elizabeth Christian Individual Corporate OfficerBoard Member Jan 1, 2024
Jason Taylor Individual Corporate OfficerBoard Member Jan 1, 2024
Tina Wheelis Individual Corporate OfficerBoard Member Jan 1, 2024
Jeff Showalter Individual Corporate OfficerSecretary Jan 1, 2024
Shawna Baxter Individual W-2 Managing EmployeeDelegated Official Aug 28, 2023
Kevin S Rose Individual Corporate OfficerChair Jan 1, 2024
Kay Ann Housdan Individual Corporate OfficerAssistant Director Jan 1, 2024
Randy Cross Individual Corporate OfficerVice-Chairman Jan 1, 2024
Lisa Lambert Individual Corporate DirectorExecutive Director Jan 31, 2000
William Tyler Fowlkes Individual Corporate OfficerTreasurer Jan 1, 2024

All facility ownership & control disclosures 16

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
White River Medical CenterBatesville, AR, CCN 040119 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 31, 1976
Jan 31, 1976
Stone County Medical CenterMountain View, AR, CCN 041310 Hospital Operational/Managerial Control Jan 1, 2008
Stone County Medical CenterMountain View, AR, CCN 04Z310 Hospital 5% Or Greater Direct Ownership Interest Apr 1, 1999
White River Medical CenterBatesville, AR, CCN 04S119 Hospital Operational/Managerial Control Dec 21, 2007
White River Medical Center Rehabilitation UnitBatesville, AR, CCN 04T119 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Melbourne Medical ClinicMelbourne, AR, CCN 043997 Rural health clinic Operational/Managerial Control Oct 16, 2007
Drasco Medical ClinicDrasco, AR, CCN 043455 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 1996
Cave City Medical ClinicCave City, AR, CCN 043982 Rural health clinic Operational/Managerial Control Nov 19, 1991
Plesant Plains Medical ClinicPleasant Plains, AR, CCN 043422 Rural health clinic Operational/Managerial Control Jul 1, 2006
White River Health Family CareMountain View, AR, CCN 043884 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2015
Sugarloaf Medical ClinicHeber Springs, AR, CCN 043914 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021
White River Health Family CareNewark, AR, CCN 048540 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family CareBatesville, AR, CCN 048539 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family CareSouthside, AR, CCN 048541 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Care FamilyBatesville, AR, CCN 048542 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023
White River Health Children's ClinicBatesville, AR, CCN 048543 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1568432144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 HARRISON ST",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017303",
            "telephone_number": "870-257-6060",
            "fax_number": "870-257-7667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 HOSPITAL DR",
            "city": "CHEROKEE VILLAGE",
            "state": "AR",
            "postal_code": "725297314",
            "telephone_number": "870-257-6060",
            "fax_number": "870-257-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "870-262-5545"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120685729",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midway Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cherokee Village, AR

Sources for this page

Verify at the official NPI Registry.