Conway Regional Medical Center, Inc
Organization Active NPI Psychiatry Physician · Conway, AR
NPI 1730402249 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1730402249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- CONWAY REGIONAL MEDICAL CENTER, INC
- Practice address
- 495 Hogan LN Ste 2
Conway, AR 72034-8498 - Phone
- (501) 358-6695
- Fax
- (501) 358-6860
- NPI assigned
- Mar 11, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- CONWAY REGIONAL MEDICAL CENTER
Authorized official
- Name
- William Pack
- Title
- Cfo
- Phone
- (501) 450-2112
Owners & managing parties with NPI records 3
-
Thad Ridge Hardin, M.D.
-
Thaddeus Michael Stanton, M.D.
Other NPIs on the same Medicare enrollment 11
Related certifications (CCN) 3
Practitioners 13
-
David Robert Draney, D.O.
-
Marina Taylor Gray, APRN
-
Brian Howard, DO
-
Christopher David Lewis, D.O.
-
Anne McVay, PMHNP-BC
-
Tequlia Monikia Pickrom, LMSW
-
Londa Lynne Revis, LCSW
-
Timothy Scott Spurlin, MNSC, APRN, PMHNP-BC
-
Ronald J Wauters, MD
-
Robert G Wooten, MD
-
Austin Goebel, DO
Affiliated clinicians 490
-
Jose Abiseid, M.D.
-
Dana C Abraham, M.D.
-
Ladly Abraham, MD
-
Shirisha Ale, MBBS
-
Justin Lane Alexander, CRNA
-
Ahmed Ali, MD
-
Ashley Allen, PA-C
-
Justin Allen, MD
-
Moustafa Aly, MD
-
Megan Andres, APRN
-
Edward E Angtuaco, M.D.
-
Becca Carle Austin, APN
-
Mallory Bagwell, DO
-
Diaa An Bahgat, MD.
-
Phillip Scott Ballinger, M.D.
-
Jodi M Barboza, MD
-
Tyeler Barker, MD
-
Jaafar Basma, M.D.
Medicare Care Compare: Hospital
- Listed as
- Conway Regional Medical Center, Inc
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Hospital certification: CCN 040029
- Legal name
- CONWAY REGIONAL MEDICAL CENTER INC
- Doing business as
- CONWAY REGIONAL MEDICAL CENTER INC
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jun 25, 2021
- Beds
- 150
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 26, 1938 in AR
- Enrollment address
- 2302 College Avenue
Conway, AR 72034-6297 - Hospital subgroups
- Acute care, Psychiatric unit
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Allison Bramlett |
W-2 Managing Employee |
Jan 1, 2024 | |
| Susan Gatto |
Operational/Managerial Control |
Jan 1, 2022 | |
| Thaddeus Michael Stanton |
Operational/Managerial Control |
Jan 1, 2024 | |
| William Pack |
W-2 Managing Employee |
Aug 29, 2022 | |
| Operational/Managerial Control |
Aug 29, 2022 | ||
| Matthew Troup |
Corporate Officer |
Sep 14, 2015 | |
| Jeremy O Riddle |
Operational/Managerial Control |
Jan 1, 2024 | |
| Thad R Hardin |
Operational/Managerial Control |
Jan 1, 2017 | |
| Jeffrey Standridge |
Operational/Managerial Control |
Jan 1, 2017 | |
| Tom Poe |
Operational/Managerial Control |
Jan 1, 2013 | |
| Gena Ester |
Operational/Managerial Control |
Jan 1, 2022 | |
| Andrew Cole |
Operational/Managerial Control |
Jan 1, 2012 | |
| Wayne Cox |
Operational/Managerial Control |
Jan 1, 2013 | |
| Bryan Bruich |
Operational/Managerial Control |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040605000199 | AR | Part B Supplier - Clinic/Group Practice | 3173428414 |
Receives reassigned benefits from 50 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Conway, AR; Vilonia, AR; Russellville, AR; Pottsville, AR; Mayflower, AR; Greenbrier, AR; Clinton, AR |
| O20071201000077 | AR | Part a Provider - Hospital | 3173428414 |
5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Conway, AR; Vilonia, AR; Russellville, AR; Greenbrier, AR; Mayflower, AR |
National Provider Directory
- Part of
- Center Ridge Family Med
Locations
2302 College Ave
#302
Conway, AR 72034
2302 College Ave
#301
Conway, AR 72034
Phone (501) 319-7437
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X |
Addresses
Primary practice location
495 Hogan LN Ste 2
Conway, AR 72034-8498
Mailing address
PO Box 9662
Conway, AR 72033-9662
Phone (501) 358-6695
Other names
- CONWAY REGIONAL COUNSELING CENTER
Other providers in Conway, AR
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc
- Conway Regional Medical Center, Inc.
- Conway Regional Medical Center, Inc.
- Conway Regional Medical Center, Inc.
All providers in Conway, AR · Psychiatry Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.