NPIMap

Organization Active NPI

Northeast Arkansas Clinic Charitable Foundation, Inc.

Doing business as NEA Baptist Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
National Provider Identifier
1861721839
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.
Doing business as
NEA Baptist Clinic
Practice address
4802 E Johnson Ave
Jonesboro, AR 72401-8413
Phone
(870) 936-8000
Fax
(870) 936-0100
NPI assigned
Dec 21, 2009
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Gregory M Duckett
Title
Sr VP/Clo
Phone
(901) 227-5233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

4802 E Johnson Ave
Jonesboro, AR 72401-8413

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Other names 1

  • NEA Baptist Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100315000190 AR Part B Supplier - Clinic/Group Practice 2961547526 Receives reassigned benefits from 442 practitioners
2 other NPIs on this enrollment
Practice locations: Jonesboro, AR; Manila, AR; Newport, AR; Osceola, AR; Paragould, AR; Trumann, AR; Blytheville, AR; Brookland, AR…

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Baptist Memorial Health Care Corp

Locations

2205 W Parker Rd
Jonesboro, AR 72404
Phone (870) 933-9250

4901 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 932-8222

616 W Keiser Ave
Osceola, AR 72370
Phone (870) 563-5888

516 Industrial Park Dr
Trumann, AR 72472
Phone (870) 483-6131

Practitioners & affiliated clinicians

Practitioners 447

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.

View all 447

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1861721839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177",
            "fax_number": "870-936-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724018413",
            "telephone_number": "870-936-8000",
            "fax_number": "870-936-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2009-12-21",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP/CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEA Baptist Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NEA Baptist Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.