NPIMap

Organization Active NPI

East Arkansas Family Health Center Inc.

Doing business as Trumann Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Trumann, AR
National Provider Identifier
1578889622
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST ARKANSAS FAMILY HEALTH CENTER INC.
Doing business as
Trumann Family Health Center
Practice address
417 W Main St
Trumann, AR 72472-3116
Phone
(870) 483-1025
Fax
(870) 483-6683
NPI assigned
Apr 14, 2010
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Susan E Ward-Jones, M.D.NPI 1851368740
Title
Ceo
Phone
(870) 735-3842

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

417 W Main St
Trumann, AR 72472-3116

Mailing address

900 N 7TH St
West Memphis, AR 72301-2001
Phone (870) 735-3842

Other names 1

  • Trumann Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100611000825 AR Part A Provider - Federally Qualified Health Center (FQHC) 1052390390 Practice locations: Trumann, AR
O20101006000058 AR Part B Supplier - Clinic/Group Practice 1052390390 Receives reassigned benefits from 21 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blytheville, AR
O20110503000659 AR Part B Supplier - Clinic/Group Practice 1052390390 Receives reassigned benefits from 22 practitioners
Practice locations: Trumann, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578889622. Details of each certification follow.

Federally qualified health center certification: CCN 041873

Legal name
EAST ARKANSAS FAMILY HEALTH CENTER, INC
Doing business as
TRUMANN FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2010
Last certification
Jun 14, 2010
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
417 West Main Street
Trumann, AR 72472-3116

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Reena Holmes Individual Corporate OfficerCfo Jan 1, 2021
Susan Ward Jones Individual Corporate Director Mar 8, 2010
W-2 Managing Employee Mar 8, 2010
Larry Robinson Individual Corporate DirectorBoard Member Jun 18, 2014
Cynthia Conner Individual Corporate DirectorBoard Member Aug 24, 2020
Randall S Burcham Individual Corporate DirectorBoard Member May 26, 2015
Kyle Miller Individual Corporate Director Sep 23, 2019
Sara Joplin Individual Corporate DirectorBoard Member Aug 24, 2020
Dewayne Rose Individual Corporate DirectorBoard Member Feb 1, 2023
Sandra Teague Individual Corporate DirectorBoard Member Jul 23, 2012
Tracy Evans Individual Corporate DirectorBoard Chair May 26, 2015

Owners & managing parties with NPI records 2

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
Marion School District School Based Health CenterMarion, AR, CCN 041941 Federally qualified health center Operational/Managerial Control (100%) Aug 13, 2018

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1271203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1578889622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N 7TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723012001",
            "telephone_number": "870-735-3842",
            "fax_number": "870-483-6683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 W MAIN ST",
            "city": "TRUMANN",
            "state": "AR",
            "postal_code": "724723116",
            "telephone_number": "870-483-1025",
            "fax_number": "870-483-6683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ARKANSAS FAMILY HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-14",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "WARD-JONES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-735-3842",
        "authorized_official_credential": "M.D."
    },
    "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": "Trumann Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trumann Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trumann, AR

Sources for this page

Verify at the official NPI Registry.