NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc

Doing business as Jefferson Regional Healthworks

  • Clinic/Center
  • Pine Bluff, AR
National Provider Identifier
1841235868
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC
Doing business as
Jefferson Regional Healthworks
Practice address
4201 S Mulberry St Ste a
Pine Bluff, AR 71603-7002
Phone
(870) 536-6600
Fax
(870) 534-1519
NPI assigned
Jun 17, 2006
Last updated
Apr 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Authorized official

Name
Bryan Jackson
Title
VP/Chief Admin Officer
Phone
(870) 541-7141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X AR Primary

Addresses

Primary practice location

4201 S Mulberry St Ste a
Pine Bluff, AR 71603-7002

Mailing address

4201 S Mulberry St Ste a
Pine Bluff, AR 71603-7002
Phone (870) 536-6600

Other identifiers 2

IdentifierTypeStateIssuer
56802OtherARBLUE CROSS BLUE SHIELD
CI2242OtherARRAILROAD MEDICARE

Other names 1

  • Jefferson Regional Healthworks Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070913000776 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 9 practitioners
Practice locations: Pine Bluff, AR

Other NPIs with the same Medicare PAC ID 8

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

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
04D0698656Jefferson Regional Healthworks4201 S Mulberry Street, Pine Bluff, AR 71603Certificate of waiverNov 30, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 5

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 Monticello Medical ClinicMonticello, AR, CCN 048533 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 1966
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 5

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1841235868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 S MULBERRY ST STE A",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037002",
            "telephone_number": "870-536-6600",
            "fax_number": "870-541-8623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 S MULBERRY ST STE A",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037002",
            "telephone_number": "870-536-6600",
            "fax_number": "870-534-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "VP/CHIEF ADMIN OFFICER",
        "authorized_official_telephone_number": "870-541-7141"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "56802",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI2242",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Regional Healthworks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.