NPIMap

Organization Active NPI

White River Health System, Inc

Doing business as White River Med Physicians

  • Anesthesiology Physician
  • Batesville, AR
National Provider Identifier
1760410229
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
WHITE RIVER HEALTH SYSTEM, INC
Doing business as
White River Med Physicians
Practice address
1710 Harrison St
Batesville, AR 72501-7303
Phone
(870) 262-1200
Fax
(870) 262-3284
NPI assigned
Jun 30, 2006
Last updated
May 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WHITE RIVER HEALTH SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Authorized official

Name
Shawna Baxter
Title
Provider Enrollment
Phone
(870) 262-5545

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Hospitalist Physician 208M00000X
Nurse Practitioner 363L00000X

Addresses

Primary practice location

1710 Harrison St
Batesville, AR 72501-7303

Mailing address

1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 262-1200

Other identifiers 1

IdentifierTypeStateIssuer
102781002MedicaidAR

Other names 1

  • White River Med Physicians Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031203000615 AR Part B Supplier - Clinic/Group Practice 0143134270 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
Practice locations: Mountain View, AR; Newport, AR; Melbourne, AR; Heber Springs, AR; Cherokee Village, AR; Batesville, AR
O20040216000496 AR Part A Provider - Hospital 0143134270 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Batesville, AR; Mountain View, AR; Cherokee Village, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760410229. Details of each certification follow.

Hospital certification: CCN 040119

Legal name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
WHITE RIVER MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 30, 1976
Last certification
Apr 6, 2023
Beds
224
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 31, 1976 in AR
Enrollment address
1710 Harrison St
White River Medical Center
Batesville, AR 72501-7303
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

View all 13

Other NPIs on the same Medicare enrollment 16

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

View all 16

Care Compare: Hospital

Medicare Care Compare
Listed as
White River Medical CenterCCN 040119 · All quality measures
Overall star rating
3 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
Tax ID family
Pleasant Plains Medical48 organizations share this tax ID, including this one
Part of
Pleasant Plains Medical

Other organizations with this tax ID 47

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

View all 47

Locations

12 Hospital Cir
Ste B
Batesville, AR 72501
Phone (870) 262-1510

1215 Sidney St
Ste 203
Batesville, AR 72501

2397 Harrison St
Ste C
Batesville, AR 72501
Phone (870) 262-1357

501 Virginia Dr
Ste C
Batesville, AR 72501

525 Virginia Dr
Ste A
Batesville, AR 72501

521 Wilburn Rd
Heber Springs, AR 72543
Phone (501) 270-4200

224 E Matthews Ave
Jonesboro, AR 72401
Phone (501) 972-4172

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Crystal Johnson Individual Corporate DirectorBoard Member Jan 1, 2025
White River Health System, Inc. Organization, Batesville, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 31, 1976
Operational/Managerial Control Jan 31, 1976
Steve Case Individual Corporate DirectorBoard Member Jan 1, 2025
Stacy Gunderman Individual Corporate DirectorBoard Member Jan 1, 2025
Maggie Williams Individual Corporate DirectorExecutive Director Jan 1, 2025
Danny Bell Individual Corporate DirectorBoard Member Jan 1, 2025
Robert McIntire Individual Corporate DirectorTreasurer Jan 1, 2025
Elizabeth Christian Individual Corporate DirectorBoard Member Jan 1, 2025
Jason Taylor Individual Corporate DirectorBoard Member Jan 1, 2025
Tina Wheelis Individual Corporate DirectorBoard Member Jan 1, 2025
Jeff Showalter Individual Corporate DirectorSecretary Jan 1, 2025
Shawna Baxter Individual W-2 Managing EmployeeProvider Enrollment Specialist Aug 28, 2023
Kevin S Rose Individual Corporate DirectorBoard Member Jan 1, 2025
Randy Cross Individual Corporate DirectorChair Jan 1, 2025
Kathy Lanier Individual Corporate DirectorBoard Member Jan 1, 2025
Lisa Lambert Individual Corporate DirectorExecutive Director Jan 1, 2024
William Tyler Fowlkes Individual Corporate DirectorVice Chair Jan 1, 2025
Lance Lamberth Individual Corporate DirectorBoard Member Jan 1, 2025

All facility ownership & control disclosures 17

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

FacilityTypeRoleSince
White River Medical CenterBatesville, AR, CCN 040119 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 31, 1976
Jan 31, 1976
Stone County Medical CenterMountain View, AR, CCN 041310 Hospital Operational/Managerial Control Jan 1, 2008
Stone County Medical CenterMountain View, AR, CCN 04Z310 Hospital 5% Or Greater Direct Ownership Interest Apr 1, 1999
White River Medical CenterBatesville, AR, CCN 04S119 Hospital Operational/Managerial Control Dec 21, 2007
White River Medical Center Rehabilitation UnitBatesville, AR, CCN 04T119 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Midway Medical ClinicCherokee Village, AR, CCN 043981 Rural health clinic Operational/Managerial Control (100%) Sep 10, 2010
Melbourne Medical ClinicMelbourne, AR, CCN 043997 Rural health clinic Operational/Managerial Control Oct 16, 2007
Drasco Medical ClinicDrasco, AR, CCN 043455 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 1996
Cave City Medical ClinicCave City, AR, CCN 043982 Rural health clinic Operational/Managerial Control Nov 19, 1991
Plesant Plains Medical ClinicPleasant Plains, AR, CCN 043422 Rural health clinic Operational/Managerial Control Jul 1, 2006
White River Health Family CareMountain View, AR, CCN 043884 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2015
Sugarloaf Medical ClinicHeber Springs, AR, CCN 043914 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021
White River Health Family CareNewark, AR, CCN 048540 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family CareBatesville, AR, CCN 048539 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family CareSouthside, AR, CCN 048541 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Care FamilyBatesville, AR, CCN 048542 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023
White River Health Children's ClinicBatesville, AR, CCN 048543 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Practitioners & affiliated clinicians

Practitioners 32

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 32

Affiliated clinicians 353

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

View all 353

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1760410229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 HARRISON ST",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017303",
            "telephone_number": "870-262-1200",
            "fax_number": "870-262-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 HARRISON ST",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017303",
            "telephone_number": "870-262-1200",
            "fax_number": "870-262-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER HEALTH SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE RIVER HEALTH SYSTEM, INC",
        "enumeration_date": "2006-06-30",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "870-262-5545"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102781002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White River Med Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "White River Med Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Batesville, AR

Sources for this page

Verify at the official NPI Registry.