NPIMap

Organization Active NPI

Bradley Bibb MD PLLC

  • Rural Health Clinic/Center
  • Ash Flat, AR
National Provider Identifier
1699097436
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRADLEY BIBB MD PLLC
Practice address
49 Highway 62 412
Ash Flat, AR 72513-9594
Phone
(870) 994-7301
NPI assigned
Feb 21, 2010
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Monya York
Title
Controller
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X E-4136 AR

Addresses

Primary practice location

49 Highway 62 412
Ash Flat, AR 72513-9594

Mailing address

49 Highway 62 412
Ash Flat, AR 72513-9594
Phone (870) 994-7301

Other identifiers 1

IdentifierTypeStateIssuer
204415002MedicaidAR

Other names 1

  • Access Medical Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100628000488 AR Part B Supplier - Clinic/Group Practice 4789715285 Receives reassigned benefits from 95 practitioners
11 other NPIs on this enrollment
Practice locations: Ash Flat, AR; Black Rock, AR; Bono, AR; Dardanelle, AR; Hardy, AR; Marked Tree, AR; Salem, AR; Texarkana, AR
O20220827000263 AR Part A Provider - Rural Health Clinic 4789715285 Practice locations: Ash Flat, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699097436. Details of each certification follow.

Rural health clinic certification: CCN 043923

Legal name
BRADLEY BIBB MD PLLC
Doing business as
ACCESS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 22, 2022
Last certification
Nov 22, 2022
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Jul 23, 2008 in AR
Enrollment address
49 Highway 62 412
Ash Flat, AR 72513-9594

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Mark Hahn Individual 5% Or Greater Direct Ownership InterestMedical Director May 8, 2025 100%
Corporate OfficerMedical Director May 8, 2025
Jared Clifford Individual Corporate OfficerPresident May 8, 2025
Sheri N Davis Individual W-2 Managing EmployeeVP of Provider Mgmnt May 8, 2025
Monya York Individual Corporate DirectorDirector Credentialing May 8, 2025
W-2 Managing EmployeeDirector Credentialing May 8, 2025
Operational/Managerial ControlController Jul 15, 2017
Randi L Davis Individual W-2 Managing EmployeeDirector Provider Mgmnt May 8, 2025
Candice M Cartwright Individual W-2 Managing EmployeeClinic Director May 8, 2025

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 113

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 113

NPI Registry JSON

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

{
    "created_epoch": "1266710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1699097436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 HIGHWAY 62 412",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "725139594",
            "telephone_number": "870-994-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 HIGHWAY 62 412",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "725139594",
            "telephone_number": "870-994-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY BIBB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-21",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-4136",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204415002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Access Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ash Flat, AR

Sources for this page

Verify at the official NPI Registry.