NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Conway, AR
National Provider Identifier
1831809490
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC.
Practice address
1125 Skyline Dr
Conway, AR 72032-2857
Phone
(870) 448-5733
Fax
(877) 370-4292
NPI assigned
Dec 5, 2022
Last updated
Jan 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1125 Skyline Dr
Conway, AR 72032-2857

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5733

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701000737 AR Part B Supplier - Clinic/Group Practice 3870401722 Receives reassigned benefits from 58 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…
O20230127001647 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Conway, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831809490. Details of each certification follow.

Federally qualified health center certification: CCN 041022

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 10, 2023
Last certification
Jan 10, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1994 in AR
Enrollment address
1125 Skyline Dr
Conway, AR 72032-2857

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 13

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

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2273411Boston MTN Rural Health Center, Inc- Conway1125 Skyline Dr, Conway, AR 72032Certificate of waiverDec 12, 2026

National Provider Directory

National Provider Directory
Tax ID family
Boston Mountain Rural Health Center Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1125 Hwy 65 N
Conway, AR 72032

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Charles Reece Individual Corporate DirectorBoard Member Dec 1, 2012
Debbie Ackerson Individual Corporate OfficerCeo Nov 9, 2017
Christopher Graham Individual Corporate DirectorBoard Member Jan 1, 1999
David Doshier Individual Corporate DirectorBoard Member Nov 1, 2012
Donna Samples Individual Corporate DirectorBoard Member Jan 1, 2003
Rebecca Blair Individual Corporate OfficerCfo Feb 1, 2014
W-2 Managing EmployeeCfo Dec 16, 2013

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

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 1

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": "1670198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1831809490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5733",
            "fax_number": "870-448-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 SKYLINE DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720322857",
            "telephone_number": "870-448-5733",
            "fax_number": "877-370-4292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-05",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.