NPIMap

Organization Active NPI

John Ed Chambers Memorial Hospital, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Danville, AR
National Provider Identifier
1740217884
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
AR4293 Issued in AR
Legal business name
JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Practice address
719 Detroit Street
Danville, AR 72833-0639
Phone
(479) 495-2241
Fax
(479) 495-6290
NPI assigned
Jun 26, 2006
Last updated
Sep 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Michael Scott Peek
Title
Ceo
Phone
(479) 495-2241

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X AR4293 AR Primary

Addresses

Primary practice location

719 Detroit Street
Danville, AR 72833-0639

Mailing address

PO Box 639
Danville, AR 72833-0639
Phone (479) 495-2241

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070313000502 AR Part A Provider - Hospital 4688628167 Practice locations: Danville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740217884. Details of each certification follow.

Hospital certification: CCN 04U011

Legal name
JOHN ED CHAMBERS MEMORIAL HOSPITAL INC
Doing business as
CHAMBERS MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Oct 29, 1997 in AR
Enrollment address
719 Detroit Ave
Danville, AR 72833-9607
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Chambers Memorial Hospi7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John Chambers Individual Corporate DirectorBoard Member Mar 12, 1984
Michael Peek Individual Corporate OfficerCeo Jun 1, 2021 100%
W-2 Managing EmployeeCeo Jun 1, 2021 100%
Operational/Managerial ControlCeo Jun 1, 2021 100%
Tommy D Papasan Individual Corporate DirectorBoard Member Jul 16, 2014
John Ed Chambers Memorial Hospital Inc Organization, Danville, AR Corporation, Non-profit Operational/Managerial Control Jun 1, 2021 100%
Philip Alexander Individual Corporate DirectorBoard Member Aug 18, 2004
Paul Sanders Individual Corporate DirectorBoard Member Jul 1, 1995
Robert R Redfern Individual Corporate DirectorBoard Member Jul 1, 2017
Kayla Walker Individual W-2 Managing EmployeeBusiness Office Jun 1, 2021 1%
Paula M Cornwell Individual Corporate OfficerCfo Jan 1, 2021
W-2 Managing EmployeeCfo Jun 1, 2021 1%
Operational/Managerial ControlCfo Jun 1, 2021 1%
David Fisher Individual Corporate DirectorBoard Member Jul 9, 1984
Ritchie Tippin Individual Corporate Director Jul 14, 1986

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Chambers Memorial HospitalDanville, AR, CCN 040011 Hospital Operational/Managerial Control (100%) Jun 1, 2021
Chambers Memorial Hospital Home HealthDanville, AR, CCN 047096 Home health agency Operational/Managerial Control (100%) Jun 1, 2021

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1740217884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "DANVILLE",
            "state": "AR",
            "postal_code": "728330639",
            "telephone_number": "479-495-2241",
            "fax_number": "479-495-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 DETROIT STREET",
            "city": "DANVILLE",
            "state": "AR",
            "postal_code": "728330639",
            "telephone_number": "479-495-2241",
            "fax_number": "479-495-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "PEEK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-495-2241"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AR",
            "license": "AR4293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, AR

Sources for this page

Verify at the official NPI Registry.