NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Marshall, AR
National Provider Identifier
1720096027
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC
Practice address
2263 Highway 65 North
Marshall, AR 72650-1060
Phone
(870) 448-5733
Fax
(870) 448-4769
NPI assigned
Aug 3, 2006
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

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

Addresses

Primary practice location

2263 Highway 65 North
Marshall, AR 72650-1060

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5733

Other identifiers 7

IdentifierTypeStateIssuer
149029749MedicaidAR
150794749MedicaidAR
5B477OtherARBLUE CROSS
124795749MedicaidAR
DA1111OtherARRAILROAD MEDICARE GROUP
133965749MedicaidAR
135037749MedicaidAR

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701000737 AR Part B Supplier - Clinic/Group Practice 3870401722 Receives reassigned benefits from 58 practitioners
15 other NPIs on this enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…
O20070810000645 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Marshall, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720096027. Details of each certification follow.

Federally qualified health center certification: CCN 041833

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 1994
Last certification
Apr 1, 1994
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1994 in AR
Enrollment address
2263 Highway 65 North
Marshall, AR 72650-1060

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 19

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

View all 19

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
Tax ID family
Bmrhc Inc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

2263 Highway 65 N
Marshall, AR 72650
Phone (870) 741-6065

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
James Arnold Individual Corporate DirectorBoard Member Jan 1, 1994
Mary Lynn Emmett Individual Corporate DirectorBoard Member Jan 1, 2004
Charles Reece Individual Corporate DirectorBoard Member Dec 1, 2012
Debbie Ackerson Individual Corporate OfficerCeo Nov 9, 2017
Christopher Graham Individual Corporate DirectorBoard Member Jan 1, 1999
David Doshier Individual Corporate DirectorBoard Member Nov 1, 2012
Graciela Reynolds Individual Corporate DirectorBoard Member Jan 1, 2003
Donna Samples Individual Corporate DirectorBoard Member Jan 1, 2003
Rebecca Blair Individual Corporate OfficerCfo Feb 1, 2014
W-2 Managing EmployeeCfo Dec 16, 2013
Danny Horton Individual Corporate DirectorBoard Member Dec 1, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 79

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 79

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1720096027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5733",
            "fax_number": "870-448-4769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2263 HIGHWAY 65 NORTH",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5733",
            "fax_number": "870-448-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149029749",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150794749",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5B477",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124795749",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DA1111",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133965749",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135037749",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, AR

Sources for this page

Verify at the official NPI Registry.