NPIMap

Organization Active NPI

Dardanelle Regional, LLC

Doing business as Dardanelle Regional Medical Center

  • Family Medicine Physician
  • Dardanelle, AR
National Provider Identifier
1730737131
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DARDANELLE REGIONAL, LLC
Doing business as
Dardanelle Regional Medical Center
Dardanelle Regional Medical Clinic
Practice address
200 N 3Rd St Ste 1
Dardanelle, AR 72834-3802
Phone
(479) 229-6191
Fax
(479) 229-6194
NPI assigned
Aug 28, 2019
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
No

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
Brandy Talley
Title
Controller
Phone
(479) 229-4677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

200 N 3Rd St Ste 1
Dardanelle, AR 72834-3802

Mailing address

200 N 3Rd St Ste 1
Dardanelle, AR 72834-3802
Phone (479) 229-6191

Other names 2

  • Dardanelle Regional Medical Center Doing business as
  • Dardanelle Regional Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230711000936 AR Part B Supplier - Clinic/Group Practice 0345576500 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
Practice locations: Dardanelle, AR

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory
Tax ID family
Dardanelle Regional LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04M302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 041302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1730737131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N 3RD ST STE 1",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728343802",
            "telephone_number": "479-229-6191",
            "fax_number": "479-229-6194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N 3RD ST STE 1",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728343802",
            "telephone_number": "479-229-6191",
            "fax_number": "479-229-6194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARDANELLE REGIONAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "479-229-4677"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dardanelle Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dardanelle Regional Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dardanelle, AR

Sources for this page

Verify at the official NPI Registry.