NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Jasper, AR
National Provider Identifier
1609243674
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC.
Practice address
609 West Clark Street
Jasper, AR 72641-0130
Phone
(870) 429-5106
Fax
(870) 429-5108
NPI assigned
Aug 26, 2015
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

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

Addresses

Primary practice location

609 West Clark Street
Jasper, AR 72641-0130

Mailing address

609 West Clark Street
Jasper, AR 72641-0130
Phone (870) 429-5106

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701000737 AR Part B Supplier - Clinic/Group Practice 3870401722 Receives reassigned benefits from 58 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…
O20160301002636 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Jasper, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609243674. Details of each certification follow.

Federally qualified health center certification: CCN 041914

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2016
Last certification
Mar 11, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 2015 in AR
Enrollment address
609 West Clark St
Jasper, AR 72641-0130

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
04D2100550Boston Mountain Rural Health Center - Jasper609 W Clark, Jasper, AR 72641Certificate of waiverAug 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Boston MTN Rural HLTH C26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

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
Mary Lynn Emmett Individual Corporate OfficerBoard Member Apr 1, 2004
Debbie Ackerson Individual Corporate DirectorCeo Jun 3, 2017
Christopher Graham Individual Corporate OfficerVice Chair Apr 11, 1999
Graciela Reynolds Individual Corporate OfficerBoard Member Mar 9, 2003
Donna Samples Individual Corporate OfficerBoard Member Sep 26, 2003
Rebecca Blair Individual Operational/Managerial ControlCfo Dec 13, 2013

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

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 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": "1440547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1609243674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 WEST CLARK STREET",
            "city": "JASPER",
            "state": "AR",
            "postal_code": "726410130",
            "telephone_number": "870-429-5106",
            "fax_number": "870-429-5108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 WEST CLARK STREET",
            "city": "JASPER",
            "state": "AR",
            "postal_code": "726410130",
            "telephone_number": "870-429-5106",
            "fax_number": "870-429-5108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-26",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, AR

Sources for this page

Verify at the official NPI Registry.