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Boston Mountain Rural Health Center Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Conway, AR

NPI 1831809490 · NPPES record last updated Jan 3, 2023

Key facts

NPI
1831809490
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 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
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 1

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

Other NPIs on the same Medicare enrollment 13

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

Other NPIs with the same Medicare PAC ID 19

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

Corporate family (same tax ID) 24

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

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2273411Boston MTN Rural Health Center, Inc- Conway
1125 Skyline Dr, Conway, AR 72032		Certificate of waiverDec 12, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AR

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
Corporation · Non-profit
Incorporated
Jun 1, 1994 in AR
Enrollment address
1125 Skyline Dr
Conway, AR 72032-2857

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 Director
Board Member		 Dec 1, 2012
Debbie Ackerson
Individual 		Corporate Officer
Ceo		 Nov 9, 2017
Christopher Graham
Individual 		Corporate Director
Board Member		 Jan 1, 1999
David Doshier
Individual 		Corporate Director
Board Member		 Nov 1, 2012
Donna Samples
Individual 		Corporate Director
Board Member		 Jan 1, 2003
Rebecca Blair
Individual 		Corporate Officer
Cfo		 Feb 1, 2014
W-2 Managing Employee
Cfo		 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, Inc
Marshall, AR · CCN 041984		 Federally qualified health center Other Mar 14, 1994

Medicare enrollment records

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

National Provider Directory

Tax ID family
Boston Mountain Rural Health Center Inc (25 organizations share this tax ID)

Locations

1125 Hwy 65 N
Conway, AR 72032

Specialties & licenses

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

Addresses

Primary practice location

1125 Skyline Dr
Conway, AR 72032-2857

Mailing address

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

Other providers in Conway, AR

All providers in Conway, AR · Federally Qualified Health Center (FQHC) in Arkansas

Sources for this page

Verify at the official NPI Registry.