NPIMap

Organization Active NPI

Conway Regional Medical Center, Inc

Doing business as Conway Regional Counseling Center

  • Psychiatry Physician
  • Conway, AR
National Provider Identifier
1730402249
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CONWAY REGIONAL MEDICAL CENTER, INC
Doing business as
Conway Regional Counseling Center
Practice address
495 Hogan LN Ste 2
Conway, AR 72034-8498
Phone
(501) 358-6695
Fax
(501) 358-6860
NPI assigned
Mar 11, 2010
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CONWAY REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
William Pack
Title
Cfo
Phone
(501) 450-2112

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary
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 1

  • CONWAY REGIONAL COUNSELING CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730402249. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 26, 1938 in AR
Enrollment address
2302 College Avenue
Conway, AR 72034-6297
Other Hospital Practice Location
Hospital subgroups
Acute care, Psychiatric unit

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Conway Regional Medical Center, IncCCN 040029 · All quality measures
Overall star rating
2 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
Part of
Conway Reg Med Ctr Inc

Locations

2302 College Ave
#302
Conway, AR 72034

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Allison Bramlett Individual W-2 Managing EmployeeDelegated Official Jan 1, 2024
Susan Gatto Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Thaddeus Michael Stanton Individual Operational/Managerial ControlBoard Member Jan 1, 2024
William Pack Individual W-2 Managing EmployeeCfo Aug 29, 2022
Operational/Managerial ControlCfo Aug 29, 2022
Matthew Troup Individual Corporate OfficerPresident & Ceo Sep 14, 2015
Jeremy O Riddle Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Thad R Hardin Individual Operational/Managerial ControlBoard Member Jan 1, 2017
Jeffrey Standridge Individual Operational/Managerial ControlBoard Member Jan 1, 2017
Tom Poe Individual Operational/Managerial ControlBoard Member Jan 1, 2013
Gena Ester Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Andrew Cole Individual Operational/Managerial ControlBoard Member Jan 1, 2012
Wayne Cox Individual Operational/Managerial ControlBoard Member Jan 1, 2013
Bryan Bruich Individual Operational/Managerial ControlBoard Member Jan 1, 2022

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

Affiliated clinicians 490

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

View all 490

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1730402249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9662",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720339662",
            "telephone_number": "501-358-6695",
            "fax_number": "501-358-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 HOGAN LN STE 2",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348498",
            "telephone_number": "501-358-6695",
            "fax_number": "501-358-6860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY REGIONAL MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONWAY REGIONAL MEDICAL CENTER",
        "enumeration_date": "2010-03-11",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "PACK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "501-450-2112"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CONWAY REGIONAL COUNSELING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.