NPIMap

Organization Active NPI

Area Agency on Aging of Western Arkansas, Inc

  • Home Health Agency
  • Booneville, AR
National Provider Identifier
1679539720
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Practice address
550 Heritage Dr
Booneville, AR 72927-3862
Phone
(479) 675-4234
NPI assigned
Apr 25, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Diane Sutton
Title
Chief Operating Officer
Phone
(479) 783-4500

Owners & managing parties with NPI records 6

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

Other NPIs on the same Medicare enrollment 1

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

Affiliated clinicians 3

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Area Agency on Aging of Western Arkansas IncCCN 047156
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Jul 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

Medicare participation

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

Home health agency certification: CCN 047156

Medicare enrollment files
Legal name
AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1995
Last certification
Jan 10, 2019
Ownership / control type
Proprietary
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1977 in AR
Enrollment address
333 S 1St St
Paris, AR 72855-4453
HHA Branch

All disclosed owners & managing parties 13

Medicare enrollment files

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

NameRoleSinceShare
Jim Petty Individual Corporate DirectorBoard Member Oct 22, 2020
Ricky R Green Individual Corporate DirectorBoard Member Jul 25, 2019
Candice Settle Individual Corporate DirectorBoard Member Feb 25, 2021
Robert Herrera Individual Corporate DirectorBoard Member Apr 27, 2017
Jake Sibley Individual Corporate Officer2ND Vice Chairperson Jan 28, 2021
Jennifer Hallum Individual Corporate OfficerCeo/President Sep 3, 2015
W-2 Managing EmployeeCeo Sep 3, 2015
Phillip Merry Individual Corporate Officer1St Vice Chairperson/Sec-Treasurer Jan 28, 2021
Area Agency on Aging of Western Arkansas, Inc Organization, Fort Smith, AR Non-profit 5% Or Greater Direct Ownership Interest Jun 20, 1979 100%
Sharon Brooks Individual Corporate DirectorBoard Member Feb 23, 2011
Dana Callaway Individual Corporate OfficerVice President Finance Jun 22, 2016
W-2 Managing EmployeeVice President Finance Jun 22, 2016
Mont Sagely Individual Corporate DirectorBoard Member Feb 23, 2023
Doug Kinslow Individual Corporate DirectorBoard Member Apr 27, 2017
T.R. McNutt Individual Corporate OfficerChairman of the Board Jan 28, 2021

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20070914000506 AR Part a Provider - Home Health Agency 5991707127 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Paris, AR

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

550 Heritage Dr
Booneville, AR 72927-3862

Mailing address

524 Garrison Ave
PO Box 1724
Fort Smith, AR 72901-2514

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 6, 2011.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1679539720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 GARRISON AVE",
            "address_2": "PO BOX 1724",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729012514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 HERITAGE DR",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729273862",
            "telephone_number": "479-675-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "479-783-4500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, AR

Sources for this page

Verify at the official NPI Registry.