NPIMap

Organization Active NPI

First Care Family Medicine-Mena PLLC

  • Family Medicine Physician
  • Mena, AR
National Provider Identifier
1619410040
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FIRST CARE FAMILY MEDICINE-MENA PLLC
Practice address
1706 Highway 71 N
Mena, AR 71953-8917
Phone
(501) 625-7500
Fax
(501) 625-7777
NPI assigned
Dec 3, 2016
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Brenda Larie Southerland
Title
Business Office Manager
Phone
(501) 625-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1706 Highway 71 N
Mena, AR 71953-8917

Mailing address

1661 Airport Rd
Suite D
Hot Springs, AR 71913-7951
Phone (501) 625-7500

Other identifiers 1

IdentifierTypeStateIssuer
225469002MedicaidAR

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315001542 AR Part B Supplier - Clinic/Group Practice 5698665685 Receives reassigned benefits from 92 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Amity, AR; Hot Springs, AR; Norman, AR; Pearcy, AR; Poyen, AR
O20180228000200 AR Part B Supplier - Clinic/Group Practice 3375804784 Receives reassigned benefits from 33 practitioners
Practice locations: Mena, AR

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Locations

1706 Highway 71 N
Mena, AR 71953
Phone (479) 394-1500

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1480723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1619410040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 AIRPORT RD",
            "address_2": "SUITE D",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719137951",
            "telephone_number": "501-625-7500",
            "fax_number": "501-625-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 HIGHWAY 71 N",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719538917",
            "telephone_number": "501-625-7500",
            "fax_number": "501-625-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CARE FAMILY MEDICINE-MENA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-03",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "SOUTHERLAND",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LARIE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "501-625-7500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225469002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mena, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.