NPIMap

Organization Active NPI

Crossett Health Foundation

Doing business as Ashley County Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Crossett, AR
National Provider Identifier
1649443144
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
AR4238 Issued in AR
Legal business name
CROSSETT HEALTH FOUNDATION
Doing business as
Ashley County Medical Center
Practice address
1015 Unity Rd
Crossett, AR 71635-9443
Phone
(870) 364-4111
Fax
(870) 364-3636
NPI assigned
Apr 7, 2008
Last updated
Apr 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

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

Authorized official

Name
Russ D Sword
Title
Ceo
Phone
(870) 364-1295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X AR4238 AR Primary

Addresses

Primary practice location

1015 Unity Rd
Crossett, AR 71635-9443

Mailing address

PO Box 400
Crossett, AR 71635-0400
Phone (870) 364-4111

Other names 1

  • Ashley County Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061228000007 AR Part A Provider - Critical Access Hospital 9133030117 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Crossett, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649443144. Details of each certification follow.

Hospital certification: CCN 04Z323

Legal name
CROSSETT HEALTH FOUNDATION
Doing business as
ASHLEY COUNTY MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1947 in AR
Enrollment address
1015 Unity Road, Box 400
Crossett, AR 71635-9434
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 8

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
Tax ID family
Ashley Memorial Hosp9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Beverly Arnold Individual W-2 Managing EmployeeMedicare/Medicaid Biller Jan 1, 2011 100%
Phillip Gilmore Individual Corporate OfficerCeo Jul 1, 2009 100%
W-2 Managing EmployeeCeo Jul 1, 2009 100%
Crossett Health Foundation Organization, Crossett, AR Created for acquisition 5% Or Greater Direct Ownership Interest Oct 1, 1998 100%
Shirley White Individual W-2 Managing EmployeeHuman Resources Director/Account Jan 1, 2011 100%

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Ashley County Medical CenterCrossett, AR, CCN 041323 Hospital 5% Or Greater Direct Ownership Interest Aug 1, 1945
Ashley Health ServicesCrossett, AR, CCN 043490 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Dec 1, 2001
Dec 1, 2001
Hamburg Health ClinicHamburg, AR, CCN 048501 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2012

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 48

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 48

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1649443144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "CROSSETT",
            "state": "AR",
            "postal_code": "716350400",
            "telephone_number": "870-364-4111",
            "fax_number": "870-364-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 UNITY RD",
            "city": "CROSSETT",
            "state": "AR",
            "postal_code": "716359443",
            "telephone_number": "870-364-4111",
            "fax_number": "870-364-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSETT HEALTH FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "SWORD",
        "authorized_official_first_name": "RUSS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-364-1295"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AR",
            "license": "AR4238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ashley County Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crossett, AR

Sources for this page

Verify at the official NPI Registry.