Access Medical Clinic Arkansas LTC LLC
Organization Active NPI Rural Health Clinic/Center · Greenbrier, AR
NPI 1780246959 · NPPES record last updated Jan 8, 2024
Key facts
- NPI
- 1780246959
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
- Practice address
- 20 Wilson Farm Rd
Greenbrier, AR 72058 - Phone
- (501) 679-8970
- Fax
- (870) 895-2164
- NPI assigned
- Jul 8, 2019
- Organization subpart
- No
Authorized official
- Name
- Monya York
- Title
- Controller
- Phone
- (870) 856-1202
Owners & managing parties with NPI records 2
-
Randi L Davis, APRN
-
Mark S Hahn, DO
Other NPIs on the same Medicare enrollment 44
Other NPIs with the same Medicare PAC ID 8
Member of 1
Facilities with the same owner 7
Practitioners 145
-
Colleen Marie Blanchard, APRN-CNP
-
James Ryan Carroll, APRN
-
Staci Rachelle Cochran, FNP-C
-
Ashley Dion Evans, APRN
-
Linzy Gavin, APRN
-
Dillon Clifford Louton, APRN
-
Rickey Edna Mack, CNP
-
Yolonda E Reed, NP-C
-
Sarah Teague, APRN
-
Brandon M Thurow, MD
-
Lawrence A Weisenbach, APRN
-
Ebony Baker, NP
-
Jody A Barham, APN
-
Sara Bayird, APRN
-
Neeraj Bharany, M.D.
-
Shannon Black, FNP-BC
-
Verona Tice Brown-Bebow, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2290490 | Access Medical Clinic Arkansas LTC LLC | Certificate of waiver | Sep 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in AR
Rural health clinic certification: CCN 043909
- Legal name
- ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 7, 2020
- Last certification
- May 7, 2020
- Ownership / control type
- 1C
- Most recent change of ownership
- Jan 1, 2024 (1 total)
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 24, 2023 in AR
- Enrollment address
- 20 Wilson Farm Rd
Greenbrier, AR 72058-9310
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Howard Freeman |
Corporate Director |
May 19, 2026 | |
| W-2 Managing Employee |
May 19, 2026 | ||
| Operational/Managerial Control |
May 19, 2026 | ||
| Mark Hahn |
5% Or Greater Indirect Ownership Interest | May 8, 2025 | 100% |
| Corporate Director |
May 8, 2025 | ||
| Tony D James |
Corporate Officer |
May 19, 2026 | |
| W-2 Managing Employee |
May 19, 2026 | ||
| Jared Clifford |
Corporate Officer |
May 19, 2026 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Access Medical Clinic Arkansas LLC |
5% Or Greater Direct Ownership Interest | Jul 24, 2023 | 100% |
| Monya York |
Corporate Director |
May 8, 2025 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Randi L Davis |
Corporate Director |
May 19, 2026 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Operational/Managerial Control |
May 19, 2026 | ||
| Kasey Crawford |
Corporate Director |
May 19, 2026 | |
| W-2 Managing Employee |
May 19, 2026 | ||
| Operational/Managerial Control |
May 19, 2026 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jan 1, 2024 | Change of Ownership |
Access Medical Clinic Arkansas LLC |
| Jan 1, 2024 | Change of Ownership |
Access Medical Clinic Arkansas LTC LLC |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170124001288 | AR | Part B Supplier - Clinic/Group Practice | 5890077093 |
Receives reassigned benefits from 171 practitioners 43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Heber Springs, AR; Hope, AR; Lamar, AR; Mena, AR; Mountain Home, AR; Newport, AR; Osceola, AR; Ozark, AR… |
| O20231130000759 | AR | Part a Provider - Rural Health Clinic | 0547618175 | Practice locations: Greenbrier, AR |
| O20231208000065 | AR | Part B Supplier - Clinic/Group Practice | 0547618175 |
Receives reassigned benefits from 126 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Malvern, AR; Weiner, AR; Perryville, AR; Marshall, AR; Lonoke, AR; Greenbrier, AR; Concord, AR; Cave City, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
20 Wilson Farm Rd
Greenbrier, AR 72058
Mailing address
101 W Main St
Hardy, AR 72542-9566
Other providers in Greenbrier, AR
- A Better Approach ABA Inc
- Catherine Acre
- Payton Adkins
- Lauren Marie Alexander
- Abigail Angeles
- Arkansas Health Group
All providers in Greenbrier, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.