NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc

Doing business as Jefferson Regional Monticello Medical Clinic

  • Rural Health Clinic/Center
  • Monticello, AR
National Provider Identifier
1821749946
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC
Doing business as
Jefferson Regional Monticello Medical Clinic
Practice address
906 Roberts Dr
Monticello, AR 71655-5724
Phone
(870) 460-4763
NPI assigned
Jan 11, 2022
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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

Authorized official

Name
Jeremy Jeffery
Title
Cfo
Phone
(870) 541-5945

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

906 Roberts Dr
Monticello, AR 71655-5724

Mailing address

PO Box 2650
Pine Bluff, AR 71613-2650

Other names 2

  • Jefferson Regional Monticello Medical Clinic Doing business as
  • Jefferson Regional Monticello Medical Clinic 2 Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040106000512 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 105 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pine Bluff, AR; Sheridan, AR; Star City, AR; Stuttgart, AR; Warren, AR; White Hall, AR; Crossett, AR; De Witt, AR…
O20220325000769 AR Part A Provider - Rural Health Clinic 8123927431 Practice locations: Monticello, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821749946. Details of each certification follow.

Rural health clinic certification: CCN 048533

Legal name
JEFFERSON HOSPITAL ASSOCIATION, INC
Doing business as
JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 2022
Last certification
Aug 7, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 30, 1966 in AR
Enrollment address
906 Roberts Dr
Monticello, AR 71655-5724
Related CCNs
040071

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Davis Nursing Home15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

773 Roberts Dr
Monticello, AR 71665

1420 W 43rd Ave
Ste A
Pine Bluff, AR 71603
Phone (870) 541-6015

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Peter Austin Individual Corporate OfficerChief Operating Officer Feb 1, 2022
W-2 Managing EmployeeChief Operating Officer Feb 1, 2022
Jefferson Hospital Association, Inc Organization, Pine Bluff, AR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 30, 1966 100%
Brian Noel Thomas Individual Corporate OfficerCeo Feb 1, 2022

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Jefferson Regional Specialty HospitalWhite Hall, AR, CCN 043038 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson Regional Specialty HospitalWhite Hall, AR, CCN 04SD38 Hospital 5% Or Greater Direct Ownership Interest (60%) Jun 4, 2024
Jefferson HomecareWhite Hall, AR, CCN 047093 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jun 1, 2008
Jefferson Regional Crossett ClinicCrossett, AR, CCN 048532 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Feb 1, 2022 Change of OwnershipThis provider was the buyer MMC2CCN 043916, AR, NPI 1043716525

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 11

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": "1641859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1821749946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716132650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 ROBERTS DR",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716555724",
            "telephone_number": "870-460-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-11",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "JEFFERY",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-541-5945"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Regional Monticello Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Regional Monticello Medical Clinic 2",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monticello, AR

Sources for this page

Verify at the official NPI Registry.