NPIMap

Organization Active NPI

Johnson Regional Medical Center

Doing business as Johnson Regional Medical Center Orthopedic Clinic

  • Orthopaedic Surgery Physician
  • Clarksville, AR
National Provider Identifier
1639557226
Registry record updated Jul 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
JOHNSON REGIONAL MEDICAL CENTER
Doing business as
Johnson Regional Medical Center Orthopedic Clinic
Practice address
1 Medicine Dr
Clarksville, AR 72830-4431
Phone
(479) 754-5405
Fax
(479) 754-4441
NPI assigned
May 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2015

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

Authorized official

Name
Edward Anderson
Title
Authorized Offical
Phone
(479) 754-5405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1 Medicine Dr
Clarksville, AR 72830-4431

Mailing address

1 Medicine Dr
Clarksville, AR 72830-4431
Phone (479) 754-5405

Other names 1

  • Johnson Regional Medical Center Orthopedic Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150818003826 AR Part B Supplier - Clinic/Group Practice 1658360284 Receives reassigned benefits from 2 practitioners
Practice locations: Clarksville, AR

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Johnson Regional Med Ctr10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Johnson Regional Medical CenterClarksville, AR, CCN 040002 Hospital Operational/Managerial Control Jan 4, 2012
JRMC Senior Care UnitClarksville, AR, CCN 04S002 Hospital 5% Or Greater Direct Ownership Interest Jun 4, 2002

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437523200000",
    "number": "1639557226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICINE DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304431",
            "telephone_number": "479-754-5405",
            "fax_number": "479-754-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICINE DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304431",
            "telephone_number": "479-754-5405",
            "fax_number": "479-754-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2015-07-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "AUTHORIZED OFFICAL",
        "authorized_official_telephone_number": "479-754-5405"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson Regional Medical Center Orthopedic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, AR

Sources for this page

Verify at the official NPI Registry.