NPIMap

Organization Active NPI

Southern Home Healthcare Inc

  • Oxygen Equipment & Supplies (DME)
  • Jonesboro, AR
National Provider Identifier
1790787042
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
Legal business name
SOUTHERN HOME HEALTHCARE INC
Practice address
2925 S Caraway Rd Ste B
Jonesboro, AR 72401
Phone
(870) 932-0990
Fax
(870) 932-1124
NPI assigned
Jun 1, 2005
Last updated
Sep 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN HOME HEALTHCARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

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

Authorized official

Name
Steve Tricarico
Title
Owner / Manager
Phone
(870) 932-0990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X Primary

Addresses

Primary practice location

2925 S Caraway Rd Ste B
Jonesboro, AR 72401

Mailing address

2925 South Caraway Road
Jonesboro, AR 72401-7313
Phone (870) 932-0990

Other identifiers 3

IdentifierTypeStateIssuer
49852OtherARBCBS ORTHOTIC PROVIDER
150051716MedicaidAR
49854OtherARBCBS DME PROVIDER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930006544 AR DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 6709092208 Practice locations: Jonesboro, AR

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Southern Home Healthcare Inc3 organizations share this tax ID, including this one
Part of
Southern Home Healthcare Inc

Other organizations with this tax ID 2

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

Locations

2925 S Caraway Rd
Jonesboro, AR 72401
Phone (870) 932-0990

2925 S Caraway Rd
Ste B
Jonesboro, AR 72401
Phone (870) 932-0990

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1790787042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 SOUTH CARAWAY ROAD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017313",
            "telephone_number": "870-932-0990",
            "fax_number": "870-932-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 S CARAWAY RD STE B",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-932-0990",
            "fax_number": "870-932-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HOME HEALTHCARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN HOME HEALTHCARE INC",
        "enumeration_date": "2005-06-01",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "TRICARICO",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "OWNER / MANAGER",
        "authorized_official_telephone_number": "870-932-0990"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ORTHOTIC PROVIDER",
            "identifier": "49852",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150051716",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DME PROVIDER",
            "identifier": "49854",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.