NPIMap

Organization Active NPI

Mainline Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Monticello, AR
National Provider Identifier
1669401501
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MAINLINE HEALTH SYSTEMS, INC
Practice address
342 Highway 425 S
Monticello, AR 71655-4612
Phone
(870) 942-3000
Fax
(870) 942-3005
NPI assigned
Jul 2, 2006
Last updated
Mar 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Authorized official

Name
Gary Allan Nichols
Title
Ceo
Phone
(870) 942-3000

Specialties & licenses 1

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

Addresses

Primary practice location

342 Highway 425 S
Monticello, AR 71655-4612

Mailing address

342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041011000567 AR Part B Supplier - Clinic/Group Practice 5193785590 Receives reassigned benefits from 62 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, AR; Rison, AR; Sheridan, AR; Star City, AR; Star City,, AR; Warren, AR; Wilmot, AR; Eudora, AR…
O20110502000760 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193785590 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669401501. Details of each certification follow.

Federally qualified health center certification: CCN 041805

Legal name
MAINLINE HEALTH SYSTEMS INC
Doing business as
PORTLAND HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
233 N Main St
Portland, AR 71663-9230

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Locations

1371 Highway 278 W
Monticello, AR 71655
Phone (870) 367-2141

512 W Church St
Sheridan, AR 72150

400 E Arkansas St
Rm 3
Star City, AR 71667

800 N Walnut St
Warren, AR 71671
Phone (870) 226-6786

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Gary Nichols Individual Corporate DirectorCeo Sep 8, 2008
W-2 Managing EmployeeCeo Sep 8, 2008
Ron Miller Individual Corporate DirectorBoard Member Feb 15, 2011
Robert Thomas Individual Corporate DirectorBoard Member Feb 15, 2011
Brandi Poole Individual Corporate DirectorBoard Member Jan 1, 2019
Alicia Whitaker Individual Corporate DirectorBoard Member Sep 1, 2018
Mary Hollins Scott Individual Corporate DirectorBoard Member Feb 15, 2011
Keith Shepherd Individual Corporate DirectorBoard Member Jan 1, 2018
Eugene Butler Individual Corporate DirectorBoard Member Jan 1, 2016
Becky Philips Individual Corporate OfficerTreasurer Finance Chair Executive Jan 1, 2019
Elyse Knobloch Individual Corporate OfficerChief Financial Officer Aug 14, 2023
Michelle Dunbar Individual Corporate DirectorBoard Member Jan 1, 2017
Shanna Knowles Individual Corporate OfficerPersonnel Finance Jan 1, 2020

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773964800000",
    "number": "1669401501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 HIGHWAY 425 S",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554612",
            "telephone_number": "870-942-3000",
            "fax_number": "870-942-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 HIGHWAY 425 S",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554612",
            "telephone_number": "870-942-3000",
            "fax_number": "870-942-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-942-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, AR

Sources for this page

Verify at the official NPI Registry.