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Boston Mountain Rural Health Center Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Berryville, AR

NPI 1932955853 · NPPES record last updated Apr 30, 2024

Key facts

NPI
1932955853
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
BOSTON MOUNTAIN RURAL HEALTH CENTER INC
Practice address
1008 W Trimble Ave
Berryville, AR 72616-4618
Phone
(888) 912-6742
NPI assigned
Apr 30, 2024
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 19

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

Corporate family (same tax ID) 24

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

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2304464Boston MTN Rural Health Center, Inc - Berryville
1008 W Trimble Ave, Berryville, AR 72616		Certificate of waiverMay 13, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR

Federally qualified health center certification: CCN 041066

Legal name
BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 8, 2024
Last certification
May 8, 2024
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Mar 14, 1997 in AR
Enrollment address
1008 W Trimble Ave
Berryville, AR 72616-4618

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Debbie Ackerson
Individual 		Corporate Director
Ceo		 Jun 2, 2017
Christopher Graham
Individual 		Corporate Director
Board Member		 Jan 1, 1999
Debbie Holt
Individual 		Corporate Director
Board Member		 Jan 2, 2018
Donna Samples
Individual 		Corporate Director
Board Member		 Jan 1, 2003
Rebecca Blair
Individual 		Corporate Officer
Cfo		 Dec 16, 2013
W-2 Managing Employee
Cfo		 Apr 13, 2018

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, Inc
Marshall, AR · CCN 041984		 Federally qualified health center Other Mar 14, 1994

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20240521000682 AR Part a Provider - Federally Qualified Health Center (FQHC) 3870401722 Practice locations: Berryville, AR

National Provider Directory

Tax ID family
Boston Mountain Rural Health Center Inc (25 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

1008 W Trimble Ave
Berryville, AR 72616-4618

Mailing address

PO Box 1060
Marshall, AR 72650-1060
Phone (870) 448-5733

Other providers in Berryville, AR

All providers in Berryville, AR · Federally Qualified Health Center (FQHC) in Arkansas

Sources for this page

Verify at the official NPI Registry.