NPIMap

Organization Active NPI

Jefferson Hospital Association, Inc.

Doing business as Family Health Assoc of Southeast AR

  • Family Medicine Physician
  • Pine Bluff, AR
National Provider Identifier
1922578327
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JEFFERSON HOSPITAL ASSOCIATION, INC.
Doing business as
Family Health Assoc of Southeast AR
Practice address
1801 W 40TH Ave Ste 6a
Pine Bluff, AR 71603-6963
Phone
(870) 541-9373
Fax
(870) 541-0109
NPI assigned
Nov 28, 2018
Last updated
Nov 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Authorized official

Name
Mr. Bryan Jackson, CFO
Title
Chief Financial Officer
Phone
(870) 541-7141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1801 W 40TH Ave Ste 6a
Pine Bluff, AR 71603-6963

Mailing address

PO Box 2650
Pine Bluff, AR 71613-2650
Phone (870) 541-7235

Other names 1

  • Family Health Assoc of Southeast AR Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040106000512 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 105 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pine Bluff, AR; Sheridan, AR; Star City, AR; Stuttgart, AR; Warren, AR; White Hall, AR; Crossett, AR; De Witt, AR…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Hospital Assn Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

1420 W 43rd Ave
Ste A
Pine Bluff, AR 71603
Phone (870) 541-6015

1601 W 40th Ave
Ste 301C
Pine Bluff, AR 71603
Phone (870) 541-6060

1609 W 40th Ave
Ste 300
Pine Bluff, AR 71603
Phone (870) 534-3608

1801 W 40th Ave
Ste 6A
Pine Bluff, AR 71603
Phone (870) 541-7393

Practitioners & affiliated clinicians

Practitioners 5

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": "1543363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1922578327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716132650",
            "telephone_number": "870-541-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 40TH AVE STE 6A",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036963",
            "telephone_number": "870-541-9373",
            "fax_number": "870-541-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-28",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "870-541-7141",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Assoc of Southeast AR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; 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.