NPIMap

Organization Active NPI

Cabun Rural Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Amity, AR
National Provider Identifier
1629017405
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CABUN RURAL HEALTH SERVICES, INC
Practice address
329 N Hill St
Amity, AR 71921-9635
Phone
(870) 342-5006
Fax
(870) 342-5802
NPI assigned
Jun 6, 2006
Organization subpart
Yes
Parent organization
CABUN RURAL HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Authorized official

Name
Susan Diane Johnston, LPN, LRT, RMC
Title
Billing Supervisor
Phone
(870) 798-3515

Specialties & licenses 1

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

Addresses

Primary practice location

329 N Hill St
Amity, AR 71921-9635

Mailing address

PO Box 218
Amity, AR 71921-0218
Phone (870) 342-5006

Other identifiers 1

IdentifierTypeStateIssuer
143650749MedicaidAR

Other names 1

  • Amity Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040113000620 AR Part B Supplier - Clinic/Group Practice 9133029234 Receives reassigned benefits from 11 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hampton, AR; Strong, AR; Lewisville, AR; Hope, AR; Bearden, AR; Amity, AR
O20060818000550 AR Part A Provider - Federally Qualified Health Center (FQHC) 9133029234 Practice locations: Amity, AR

Federally qualified health center certification: CCN 041843

Legal name
CABUN RURAL HEALTH SERVICES, INC
Doing business as
AMITY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2001
Last certification
Apr 9, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 1977 in AR
Enrollment address
211 Main St
Amity, AR 71921-9733
Related CCNs
041835

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Cabun Clinic

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Melanie J Sheppard Individual Corporate OfficerCeo Jun 9, 2010
Operational/Managerial ControlCeo Oct 17, 2016
Susan D Johnston Individual Corporate OfficerChief Information Officer Nov 1, 2005
W-2 Managing EmployeeCio Oct 1, 2009
Operational/Managerial ControlCio Oct 17, 2016
James C Rawls Individual Corporate DirectorBoard Chair Jun 9, 2010
Marsha Luna Individual Corporate DirectorBoard Member Jan 2, 2022
Sandra J Gaskin Individual Corporate DirectorBoard Member Jun 9, 2010
Judy K Southall Individual W-2 Managing EmployeeCfo Jan 2, 2022
Tracy L Madlock Individual Corporate OfficerCoo Oct 17, 2016
W-2 Managing EmployeeCoo Oct 17, 2016
Operational/Managerial ControlCoo Oct 17, 2016
Donald R Cain Individual Corporate DirectorBoard Member Jun 9, 2010
Garry B Johns Individual Corporate DirectorBoard Member Jan 2, 2022
Travis J McNiel Individual Corporate DirectorBoard Member Mar 28, 2011
Vester Lambert Individual Corporate DirectorBoard Member Jan 2, 2022
Lillie M Randall Individual Corporate DirectorBoard Vice Chair Jun 9, 2010
Adam Bailey Individual Corporate OfficerSecretary Treasurer Jan 2, 2022

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1629017405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "AMITY",
            "state": "AR",
            "postal_code": "719210218",
            "telephone_number": "870-342-5006",
            "fax_number": "870-342-5802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 N HILL ST",
            "city": "AMITY",
            "state": "AR",
            "postal_code": "719219635",
            "telephone_number": "870-342-5006",
            "fax_number": "870-342-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CABUN RURAL HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CABUN RURAL HEALTH SERVICES, INC",
        "enumeration_date": "2006-06-06",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "870-798-3515",
        "authorized_official_credential": "LPN, LRT, RMC"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143650749",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amity Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amity, AR

Sources for this page

Verify at the official NPI Registry.