NPIMap

Organization Active NPI

Boston Mountain Rural Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Deer, AR
National Provider Identifier
1932297405
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC
Practice address
HC 31 Box 310
Deer, AR 72628
Phone
(870) 428-5391
Fax
(870) 428-5392
NPI assigned
Oct 10, 2006
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Debbie Ackerson
Title
Ceo
Phone
(870) 448-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

HC 31 Box 310
Deer, AR 72628

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5101

Other identifiers 3

IdentifierTypeStateIssuer
5B477OtherARBLUE CROSS AR
150794749MedicaidAR
DA1111OtherARRAILROAD MEDICARE GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031024000044 AR Part A Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Deer, AR
O20040701000737 AR Part B Supplier - Clinic/Group Practice 3870401722 Receives reassigned benefits from 58 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, AR; Lead Hill, AR; Marshall, AR; Mountain Home, AR; Mountain View, AR; Quitman, AR; Shirley, AR; Yellville, AR…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932297405. Details of each certification follow.

Federally qualified health center certification: CCN 041853

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 20, 2003
Last certification
Nov 20, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1994 in AR
Enrollment address
HC 31 Box 310
Deer, AR 72628-2628
Related CCNs
041833

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

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Boston Mountain Rural H25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
James Arnold Individual Corporate OfficerBoard Member Feb 1, 1994
Mary Lynn Emmett Individual Corporate DirectorBoard Member Jan 1, 2004
Charles Reece Individual Corporate OfficerBoard Member Dec 1, 2012
Debbie Ackerson Individual Corporate OfficerCeo Jun 5, 2017
Christopher Graham Individual Corporate DirectorBoard Member Jan 1, 1999
David Doshier Individual Corporate OfficerBoard Member Dec 1, 2012
Debbie Holt Individual Corporate OfficerBoard Member Jan 2, 2018
Graciela Reynolds Individual Corporate DirectorBoard Member Oct 1, 2014
Donna Samples Individual Corporate DirectorBoard Member Jan 1, 2003
Rebecca Blair Individual Corporate OfficerCfo Dec 16, 2013
W-2 Managing EmployeeCfo Dec 16, 2013
Danny Horton Individual Corporate OfficerBoard Member Feb 1, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boston Mountain Rural Health Center, IncMarshall, AR, CCN 041984 Federally qualified health center Other Mar 14, 1994

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 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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1932297405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1060",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "726501060",
            "telephone_number": "870-448-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HC 31 BOX 310",
            "city": "DEER",
            "state": "AR",
            "postal_code": "72628",
            "telephone_number": "870-428-5391",
            "fax_number": "870-428-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON MOUNTAIN RURAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "ACKERSON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-448-5733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS  AR",
            "identifier": "5B477",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150794749",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DA1111",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer, AR

Sources for this page

Verify at the official NPI Registry.