NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Harrison, AR
National Provider Identifier
1750847315
Registry record updated Feb 19, 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
1002 North Spring St.
Harrison, AR 72601
Phone
(870) 741-6373
NPI assigned
Feb 19, 2019
Last updated
Feb 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 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 NU Primary

Addresses

Primary practice location

1002 North Spring St.
Harrison, AR 72601

Mailing address

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

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
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…
O20190403001569 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Harrison, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750847315. Details of each certification follow.

Federally qualified health center certification: CCN 041947

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2019
Last certification
Apr 15, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 13, 1992 in AR
Enrollment address
1002 N Spring St
Harrison, AR 72601-2918

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2036003Boston MTN Rural Health Center, Inc-Harrison1002 N Spring St, Harrison, AR 72601Certificate of waiverJun 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Boston Mountain Rural H25 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

1094 Catholic Point Rd
Center Ridge, AR 72027
Phone (501) 893-6197

1103 W Main St
Green Forest, AR 72638
Phone (870) 438-6500

130 4th St
Quitman, AR 72131
Phone (888) 602-3647

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
James Arnold Individual Corporate DirectorBoard Member Jan 10, 2003
Mary Lynn Emmett Individual Corporate DirectorBoard Member Aug 3, 2010
Charles Reece Individual Corporate DirectorBoard Member Nov 14, 2012
Debbie Ackerson Individual Corporate DirectorCeo Dec 1, 2017
Christopher Graham Individual Corporate DirectorBoard Member Jan 10, 2003
David Doshier Individual Corporate DirectorBoard Member May 1, 2012
Debbie Holt Individual Corporate DirectorBoard Member Jan 20, 2018
Graciela Reynolds Individual Corporate DirectorBoard Member Jan 10, 2003
Donna Samples Individual Corporate DirectorBoard Member Jan 10, 2003
Rebecca Blair Individual Corporate DirectorCfo Dec 16, 2013
W-2 Managing EmployeeCfo Dec 16, 2013
Danny Horton Individual Corporate DirectorBoard Member Feb 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 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1550534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1750847315",
    "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": "870-448-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 NORTH SPRING ST.",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "72601",
            "telephone_number": "870-741-6373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-19",
        "last_updated": "2019-02-19",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrison, AR

Sources for this page

Verify at the official NPI Registry.