NPIMap

Organization Active NPI

Conway Regional Medical Center, Inc.

Doing business as Mayflower Medical Clinic

  • Rural Health Clinic/Center
  • Mayflower, AR
National Provider Identifier
1851389605
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CONWAY REGIONAL MEDICAL CENTER, INC.
Doing business as
Mayflower Medical Clinic
Practice address
606 Highway 365
Mayflower, AR 72106-9595
Phone
(501) 470-7413
Fax
(501) 470-7415
NPI assigned
Oct 6, 2005
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CONWAY REGIONAL MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
William Pack
Title
Cfo
Phone
(501) 450-2112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

606 Highway 365
Mayflower, AR 72106-9595

Mailing address

PO Box 9662
Conway, AR 72033-9662
Phone (501) 852-1363

Other identifiers 1

IdentifierTypeStateIssuer
127018002MedicaidAR

Other names 1

  • Mayflower Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040605000199 AR Part B Supplier - Clinic/Group Practice 3173428414 Receives reassigned benefits from 50 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, AR; Vilonia, AR; Russellville, AR; Pottsville, AR; Mayflower, AR; Greenbrier, AR; Clinton, AR
O20071201000077 AR Part A Provider - Hospital 3173428414 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, AR; Vilonia, AR; Russellville, AR; Greenbrier, AR; Mayflower, AR
O20230327001163 AR Part A Provider - Rural Health Clinic 3173428414 Practice locations: Mayflower, AR

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1851389605. Details of each certification follow.

Hospital certification: CCN 040029

Legal name
CONWAY REGIONAL MEDICAL CENTER INC
Doing business as
CONWAY REGIONAL MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 25, 2021
Beds
150
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1938 in AR
Enrollment address
2302 College Avenue
Conway, AR 72034-6297
Other Hospital Practice Location
Hospital subgroups
Acute care, Psychiatric unit

Rural health clinic certification: CCN 048537

Legal name
CONWAY REGIONAL MEDICAL CENTER INC
Doing business as
MAYFLOWER MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2022
Last certification
Nov 16, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 2004 in AR
Enrollment address
606 Highway 365
Mayflower Medical Clinic
Mayflower, AR 72106-9595
Related CCNs
040029

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Conway Regional Medical Center, IncCCN 040029 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Reddy Medical Clinic

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Allison Bramlett Individual W-2 Managing EmployeeDelegated Official Jan 1, 2024
Susan Gatto Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022 10%
Thaddeus Michael Stanton Individual Operational/Managerial ControlBoard Member Jan 1, 2024
William Pack Individual W-2 Managing EmployeeCfo Aug 29, 2022
Operational/Managerial ControlCfo Aug 29, 2022
Matthew Troup Individual Corporate OfficerPresident & Ceo Sep 14, 2015
Corporate OfficerChief Executive Officer Aug 17, 2015
Corporate DirectorBoard Member Aug 14, 2015
W-2 Managing EmployeeChief Executive Officer Aug 17, 2015
Jeremy O Riddle Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Thad R Hardin Individual Operational/Managerial ControlBoard Member Jan 1, 2017
Corporate DirectorBoard Member Jan 1, 2017 10%
Jeffrey Standridge Individual Operational/Managerial ControlBoard Member Jan 1, 2017
Corporate DirectorBoard Member Jan 1, 2017 10%
Tom Poe Individual Operational/Managerial ControlBoard Member Jan 1, 2013
Corporate DirectorChairman Jan 1, 2013 10%
Gena Ester Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022 10%
Andrew Cole Individual Operational/Managerial ControlBoard Member Jan 1, 2012
Corporate DirectorBoard Member Jan 1, 2012 10%
Wayne Cox Individual Operational/Managerial ControlBoard Member Jan 1, 2013
Corporate DirectorBoard Member Jan 1, 2013 10%
Bryan Bruich Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022 10%
Jim Rankin Individual Corporate DirectorBoard Member Jan 1, 2013 10%
Conway Regional Medical Center Inc Organization, Mayflower, AR Corporation 5% Or Greater Direct Ownership Interest Oct 25, 2004 100%
Alan Finley Individual Corporate OfficerCoo Aug 20, 1993
W-2 Managing EmployeeCoo Aug 2, 1993
Troy Brooks Individual Corporate OfficerChief Financial Officer Sep 20, 2018
W-2 Managing EmployeeChief Financial Officer Sep 20, 2018

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 7

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

FacilityTypeRoleSince
Conway Regional Rehabilitation Hospital LLCConway, AR, CCN 043033 Hospital 5% Or Greater Direct Ownership Interest (69.6%) Apr 6, 2004
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04Z302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 04M302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Dardanelle Regional Medical CenterDardanelle, AR, CCN 041302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2022
Conway Regional Medical Clinic - ViloniaVilonia, AR, CCN 048536 Rural health clinic Operational/Managerial Control (100%) Dec 11, 2014
Greenbrier Family MedicineGreenbrier, AR, CCN 048534 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 25, 2004
Oct 25, 2004
Clinton Medical ClinicClinton, AR, CCN 048563 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 25, 2004

Facilities with the same owner 7

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

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 490

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 490

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1851389605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9662",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720339662",
            "telephone_number": "501-852-1363",
            "fax_number": "501-852-1364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 HIGHWAY 365",
            "city": "MAYFLOWER",
            "state": "AR",
            "postal_code": "721069595",
            "telephone_number": "501-470-7413",
            "fax_number": "501-470-7415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY REGIONAL MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONWAY REGIONAL MEDICAL CENTER, INC.",
        "enumeration_date": "2005-10-06",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "PACK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "501-450-2112"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127018002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayflower Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mayflower Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mayflower, AR

Sources for this page

Verify at the official NPI Registry.