NPIMap

Organization Active NPI

River Valley Primary Care Services

Doing business as Lamar School District Health Center

  • Federally Qualified Health Center (FQHC)
  • Lamar, AR
National Provider Identifier
1699010991
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RIVER VALLEY PRIMARY CARE SERVICES
Doing business as
Lamar School District Health Center
Practice address
635 Childers Ave
Lamar, AR 72846-8161
Phone
(479) 668-4881
NPI assigned
Nov 28, 2012
Last updated
Jan 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Mr. Jerome Joseph White
Title
Executive Director
Phone
(479) 431-2050

Specialties & licenses 1

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

Addresses

Primary practice location

635 Childers Ave
Lamar, AR 72846-8161

Mailing address

PO Box 130
Ratcliff, AR 72951-0130
Phone (479) 635-5300

Other names 1

  • Lamar School District Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050503001398 AR Part B Supplier - Clinic/Group Practice 0042274276 Receives reassigned benefits from 41 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waldron, AR; Ratcliff, AR; Mulberry, AR; Mountainburg, AR; Lavaca, AR; Lamar, AR; Fort Smith, AR; Coal Hill, AR…
O20090311000506 AR Part A Provider - Federally Qualified Health Center (FQHC) 0042274276 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Smith, AR
O20131113000089 AR Part A Provider - Federally Qualified Health Center (FQHC) 0042274276 Practice locations: Lamar, AR

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1699010991. Details of each certification follow.

Federally qualified health center certification: CCN 041867

Legal name
RIVER VALLEY PRIMARY CARE SERVICES
Doing business as
NORTHSIDE CLINIC AT 6TH STREET
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 19, 2009
Last certification
Mar 19, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 29, 2003 in AR
Enrollment address
3202 N 6TH St
Fort Smith, AR 72904-4164

Federally qualified health center certification: CCN 041892

Legal name
RIVER VALLEY PRIMARY CARE SERVICES
Doing business as
LAMAR SCHOOL DISTRICT HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 15, 2013
Last certification
Nov 15, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
635 Childers Ave
Lamar, AR 72846-8161

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

421 N Main St
Mulberry, AR 72947
Phone (479) 997-1484

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Mark Luerssen Individual Corporate DirectorBoard Member Nov 1, 2005 5%
Corporate DirectorBoard Member Jan 1, 2013
Robert Redding Individual Corporate DirectorBoard Member Aug 1, 2013 5%
Corporate Director Aug 1, 2013 5%
Greg Swartz Individual Corporate DirectorBoard Member May 1, 2009 5%
Corporate DirectorBoard Member Jan 1, 2013
Gary O'Neal Individual Corporate DirectorBoard President Oct 1, 2005 5%
Corporate DirectorBoard Member Jan 1, 2013
Jerome J White Individual Corporate OfficerCeo Sep 29, 2003 100%
W-2 Managing EmployeeCeo Sep 29, 2003 100%
Operational/Managerial ControlCeo Sep 29, 2003 100%
Corporate Officer Sep 29, 2003 100%
W-2 Managing Employee Sep 29, 2003 100%
Bobby G McCartney Individual Corporate DirectorBoard Member Jul 27, 2016 5%
Corporate DirectorBoard Member Jul 27, 2016
Mary Howard Individual Corporate DirectorSecretary Jul 1, 2006 5%
Corporate DirectorBoard Member Jan 1, 2013
Carmelita Adams Individual Corporate DirectorVice President Jul 1, 2011 5%
Corporate DirectorBoard Member Jan 1, 2013
Sheila Peck Individual Corporate DirectorBoard Member Dec 1, 2022
Jessica Brown Individual Corporate DirectorBoard Member Nov 1, 2018
Laura Bryant Individual Corporate DirectorBoard Member Jun 1, 2021

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
River Valley Primary Care ServicesWaldron, AR, CCN 041940 Federally qualified health center Operational/Managerial Control (100%) May 1, 2018
Clarksville Behavioral HealthClarksville, AR, CCN 041987 Federally qualified health center 5% Or Greater Indirect Ownership Interest Sep 20, 2021
River Valley Primary Care ServicesCoal Hill, AR, CCN 041000 Federally qualified health center Operational/Managerial Control (100%) Dec 6, 2021

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1699010991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729510130",
            "telephone_number": "479-635-5300",
            "fax_number": "479-635-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 CHILDERS AVE",
            "city": "LAMAR",
            "state": "AR",
            "postal_code": "728468161",
            "telephone_number": "479-668-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY PRIMARY CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "479-431-2050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lamar School District Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lamar School District Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lamar, AR

Sources for this page

Verify at the official NPI Registry.