NPIMap

Organization Active NPI

Washington Regional Medical Center

  • Community Based Hospice Care Agency
  • Fayetteville, AR
National Provider Identifier
1811198641
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
AR3906 Issued in AR
Legal business name
WASHINGTON REGIONAL MEDICAL CENTER
Practice address
325 E Longview St
Fayetteville, AR 72703-4618
Phone
(479) 463-7385
Fax
(479) 444-7120
NPI assigned
May 30, 2007
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WASHINGTON REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Dan Ray Eckels
Title
SVP/Cfo
Phone
(479) 463-6026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X AR3906 AR Primary

Addresses

Primary practice location

325 E Longview St
Fayetteville, AR 72703-4618

Mailing address

325 E Longview St
Fayetteville, AR 72703-4618
Phone (479) 713-7385

Other identifiers 2

IdentifierTypeStateIssuer
126352747MedicaidAR
11500OtherARBLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071218000218 AR Part A Provider - Hospice 7214844034 Practice locations: Fayetteville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811198641. Details of each certification follow.

Hospice certification: CCN 041500

Legal name
WASHINGTON REGIONAL MEDICAL CENTER
Doing business as
WASHINGTON REGIONAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 22, 1985
Last certification
Jun 25, 2021
Ownership / control type
Non-Profit - Other
Organization structure
OtherNon-profit
Incorporated
May 19, 1988 in AR
Enrollment address
325 E Longview St
Fayetteville, AR 72703-4618

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Washington Regional HospiceCCN 041500 · All quality measures
Ownership
Non-Profit
Certified
Jan 22, 1985
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
King Ina L5 organizations share this tax ID, including this one
Part of
King Ina L

Other organizations with this tax ID 4

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

Locations

325 E Longview St
Fayetteville, AR 72703
Phone (479) 463-7385

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jon Michael Berry Individual Corporate DirectorDirector Jan 1, 2022
M Gareth Eck Individual Corporate DirectorBoard Member Jan 1, 2009
Thomas Olmstead Individual Corporate OfficerSr Vice President and General Co Jan 17, 2006
Karen McIntosh Individual W-2 Managing EmployeeVice President Care Transition Sep 1, 2017
Stacey Hanby Individual Corporate DirectorBoard Member Jan 1, 2009
Marshall Saviers Individual Corporate DirectorBoard Member Jan 1, 2023
James L Shackelford Individual Corporate OfficerCeo Sep 1, 2017
W-2 Managing EmployeeCeo Sep 1, 2017
Anne O'Leary-Kelly Individual Corporate DirectorDirector Jan 1, 2022
Dennis Charles Burrows Individual Corporate OfficerChief Accounting Officer Mar 1, 2023
Greg Lee Individual Corporate DirectorBoard Member Jan 1, 2010
Birch Wright Individual Corporate OfficerCoo, Administrator Aug 18, 2020
W-2 Managing EmployeeCoo, Administrator Aug 18, 2020
Neal Pendergraft Individual Corporate DirectorDirector Jan 1, 2018
George Gearhart Individual Corporate DirectorDirector Jan 1, 2020
Lucas K Campbell Individual Corporate DirectorDirector Jan 1, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Encompass Health Rehabilitation Hospital, a Partner of Washington RegiFayetteville, AR, CCN 043032 Hospital 5% Or Greater Indirect Ownership Interest (50%) Dec 31, 2007

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 3

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.

Affiliated clinicians 5

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": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1811198641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E LONGVIEW ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034618",
            "telephone_number": "479-713-7385",
            "fax_number": "479-444-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E LONGVIEW ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034618",
            "telephone_number": "479-463-7385",
            "fax_number": "479-444-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WASHINGTON REGIONAL MEDICAL CENTER",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "ECKELS",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "479-463-6026"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AR",
            "license": "AR3906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126352747",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "11500",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.