NPIMap

Organization Active NPI

St. Bernards Hospital Inc

  • Geriatric Medicine (Internal Medicine) Physician
  • Jonesboro, AR
National Provider Identifier
1891178828
Registry record updated Jul 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
ST. BERNARDS HOSPITAL INC
Practice address
303 E Matthews Ave
Suite 202
Jonesboro, AR 72401-3150
Phone
(870) 207-7555
Fax
(870) 336-5083
NPI assigned
Jul 8, 2015
Last updated
Jul 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2020

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

Authorized official

Name
Mr. Benjamin Barylske
Title
Cfo
Phone
(870) 207-4565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X Primary

Addresses

Primary practice location

303 E Matthews Ave
Suite 202
Jonesboro, AR 72401-3150

Mailing address

225 E Washington Ave
Jonesboro, AR 72401-3111
Phone (870) 207-7555

Other names 1

  • St. Bernards Senior Health Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150824001158 AR Part B Supplier - Clinic/Group Practice 0941105480 Receives reassigned benefits from 17 practitioners
Practice locations: Jonesboro, AR

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Mark M Smith MD14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

303 E Matthews Ave
Ste 202
Jonesboro, AR 72401
Phone (870) 207-7555

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Encompass Health Rehabilitation Hospital of JonesboroJonesboro, AR, CCN 043029 Hospital 5% Or Greater Direct Ownership Interest (50%) Feb 1, 2013

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 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1891178828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E WASHINGTON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013111",
            "telephone_number": "870-207-7555",
            "fax_number": "870-336-5083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E MATTHEWS AVE",
            "address_2": "SUITE 202",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013150",
            "telephone_number": "870-207-7555",
            "fax_number": "870-336-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. BERNARDS HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-08",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "BARYLSKE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-207-4565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Bernards Senior Health Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St. Bernards Senior Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.