NPIMap

Organization Active NPI

Jefferson Hospital Association Inc

  • General Acute Care Hospital
  • Pine Bluff, AR
National Provider Identifier
1710931985
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
AR4213 Issued in AR
Legal business name
JEFFERSON HOSPITAL ASSOCIATION INC
Practice address
1600 W. 40TH Avenue
Pine Bluff, AR 71603-6301
Phone
(870) 541-7100
Fax
(870) 541-7964
NPI assigned
May 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Authorized official

Name
Mrs. Kristen Jade Davis
Title
Director of Reimbursement
Phone
(870) 541-7173

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X
Rehabilitation Hospital Unit 273Y00000X
Rehabilitation Hospital Unit 273Y00000X AR4213 AR
General Acute Care Hospital 282N00000X
General Acute Care Hospital 282N00000X AR4213 AR Primary
Skilled Nursing Facility 314000000X

Addresses

Primary practice location

1600 W. 40TH Avenue
Pine Bluff, AR 71603-6301

Mailing address

1600 W. 40TH Avenue
Pine Bluff, AR 71603-6301
Phone (870) 541-7100

Other identifiers 8

IdentifierTypeStateIssuer
040071OtherARMEDICARE PART A
103078002MedicaidAR
5000023OtherARUNITED HEALTHCARE
045307OtherARMEDICARE PART A
04S071OtherARMEDICARE PART A
10071OtherARBLUE CROSS PROVIDER #
102916105MedicaidAR
15307OtherARBLUE CROSS SNF PROVIDER #

Other names 1

  • Jefferson Regional Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jrmc@jrmc.allscriptsdirect.net

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040429000375 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 17 practitioners
Practice locations: Pine Bluff, AR
O20071205000406 AR Part A Provider - Hospital 8123927431 Practice locations: White Hall, AR; Pine Bluff, AR
O20200409002822 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pine Bluff, AR

Hospital certification: CCN 040071

Legal name
JEFFERSON HOSPITAL ASSOCIATION, INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 13, 2024
Beds
300
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 21, 1959 in AR
Enrollment address
1600 W 40TH Ave
Pine Bluff, AR 71603-6301
Main/Primary Hospital Location
Hospital subgroups
Acute care

Hospital certification: CCN 042007

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SELECT SPECIALITY HOSPITAL - PINE BLUFF
Certification status
Terminated Voluntary: other reason for withdrawal, Jun 1, 2006
Provider type (POS)
Hospital – Long-term
Participating since
Nov 19, 2002
Last certification
Jun 1, 2006
Beds
30
Ownership / control type
Private (for profit)
Facility address
1600 West 40TH Street, 3Rd Floor SE
Pine Bluff, AR 71603

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Jefferson Regional Medical CenterCCN 040071
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1600 W 40th Ave
Ste 2CW
Pine Bluff, AR 71603
Phone (870) 541-7127

1600 W 42nd Ave
Pine Bluff, AR 71603
Phone (870) 534-5440

1609 W 40th Ave
Ste 300
Pine Bluff, AR 71603
Phone (870) 536-6045

1609 W 40th Ave
Ste 111
Pine Bluff, AR 71603
Phone (870) 541-3240

1600 W 40th Ave
Ste 403
Pine Bluff, AR 71603

4747 Dusty Lake Dr
Ste G2
Pine Bluff, AR 71603
Phone (870) 534-2348

1600 W 40th Ave
Ste 3SW
Pine Bluff, AR 71603
Phone (870) 541-8767

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
George Makris Individual Corporate Director Oct 1, 2010
Laurence Alexander Individual Other Oct 1, 2021
Bryan Jackson Individual Corporate Officer Mar 28, 2011
W-2 Managing Employee Mar 28, 2011
Charles G Morgan Individual Corporate Director Oct 1, 1999
Marty Casteel Individual Corporate Director Oct 1, 2006
Peter Austin Individual Corporate OfficerChief Operating Officer Nov 1, 2017
W-2 Managing Employee Nov 1, 2017
Annette Kline Individual Corporate Director Oct 1, 2004
David Brown Individual Corporate Director Oct 1, 2003
Janice Acosta Individual Corporate Director Jan 1, 2018
David Bridgforth Individual Corporate Director Jan 1, 2018
Michelle W Eckert Individual Corporate Director Oct 1, 2011
Frank Anthony Individual Corporate Director Oct 1, 2006
Jeremy Jeffery Individual Corporate OfficerSr.Vice President & Cfo Jan 1, 2022
Corporate DirectorSr. Vice President & Cfo Jan 1, 2022
W-2 Managing Employee Jan 1, 2022
Mary Louise Hickman Individual Corporate Officer Dec 28, 2003
Amy Boast Cahill Individual Other Oct 1, 2021
Joann Mays Individual Corporate Director Oct 1, 2010
Andrew Atkinson Individual Corporate Director Oct 1, 2004
Henry Trotter Individual Corporate Director Oct 1, 2010
Scott Pitillo Individual Corporate Director Oct 1, 2011
Brian Noel Thomas Individual Corporate OfficerChief Executive Officer May 30, 2010

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Jefferson Regional Specialty HospitalWhite Hall, AR, CCN 043038 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson Regional Specialty HospitalWhite Hall, AR, CCN 04SD38 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson HomecareWhite Hall, AR, CCN 047093 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jun 1, 2008
Jefferson Regional Monticello Medical ClinicMonticello, AR, CCN 048533 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966
Jefferson Regional Crossett ClinicCrossett, AR, CCN 048532 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

Affiliated clinicians 297

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

View all 297

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1710931985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W. 40TH AVENUE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7100",
            "fax_number": "870-541-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W. 40TH AVENUE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7100",
            "fax_number": "870-541-7964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "JADE",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "870-541-7173",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "AR",
            "license": "AR4213",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AR",
            "license": "AR4213",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "040071",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103078002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5000023",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "045307",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "04S071",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER  #",
            "identifier": "10071",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102916105",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SNF PROVIDER #",
            "identifier": "15307",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jrmc@jrmc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "1600 W. 40th Avenue",
            "city": "Pine Bluff",
            "state": "AR",
            "country_code": "US",
            "postal_code": "716036301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jefferson Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.