NPIMap

Organization Active NPI

River Valley Primary Care Services

  • Federally Qualified Health Center (FQHC)
  • Ratcliff, AR
National Provider Identifier
1952349003
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RIVER VALLEY PRIMARY CARE SERVICES
Practice address
9755 W State Highway 22
Ratcliff, AR 72951
Phone
(479) 431-2050
NPI assigned
Jun 2, 2006
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mr. Jerome Joseph White
Title
Ceo
Phone
(479) 431-2057

Specialties & licenses 1

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

Addresses

Primary practice location

9755 W State Highway 22
Ratcliff, AR 72951

Mailing address

9755 W State Highway 22
P.O. Box 130
Ratcliff, AR 72951-9000
Phone (479) 635-5300

Other identifiers 3

IdentifierTypeStateIssuer
156152631MedicaidAR
770106649MedicaidAR
156966749MedicaidAR

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041117000112 AR Part A Provider - Federally Qualified Health Center (FQHC) 0042274276 Practice locations: Ratcliff, AR
O20050503001398 AR Part B Supplier - Clinic/Group Practice 0042274276 Receives reassigned benefits from 41 practitioners
13 other NPIs on this enrollment
Practice locations: Waldron, AR; Ratcliff, AR; Mulberry, AR; Mountainburg, AR; Lavaca, AR; Lamar, AR; Fort Smith, AR; Coal Hill, AR…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952349003. Details of each certification follow.

Federally qualified health center certification: CCN 041855

Legal name
RIVER VALLEY PRIMARY CARE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2004
Last certification
Dec 15, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 29, 2003 in AR
Enrollment address
9755 W State Highway 22
Ratcliff, AR 72951-9000

Other NPIs with the same Medicare PAC ID 14

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

View all 14

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

Locations

106 N Hill St
Clarksville, AR 72830
Phone (479) 307-8760

2000 E Wood St
Paris, AR 72855
Phone (479) 963-1516

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Mark Luerssen Individual Corporate DirectorBoard Member Sep 1, 2005
Robert Redding Individual Corporate DirectorBoard Member Aug 1, 2013
Greg Swartz Individual Corporate DirectorTreasurer Apr 1, 2009
Sheila Peck Individual Corporate DirectorBoard Member Dec 1, 2022
Gary O'Neal Individual Corporate DirectorBoard President Sep 1, 2005
Jerome J White Individual Corporate DirectorCeo Apr 4, 2005
W-2 Managing EmployeeCeo Apr 4, 2005
Nathan H Bennett Individual Corporate DirectorMedical Director Apr 1, 2019 5%
W-2 Managing EmployeeMedical Director Apr 1, 2019 5%
Bobby G McCartney Individual Corporate DirectorBoard Member Jun 1, 2015
Mary Howard Individual Corporate DirectorSecretary May 1, 2006
Jessica Brown Individual Corporate DirectorBoard Member Dec 12, 2018
Laura Bryant Individual Corporate DirectorBoard Member Jun 1, 2021
Carmelita Adams Individual Corporate DirectorBoard Vice President May 1, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
River Valley Primary Care ServicesWaldron, AR, CCN 041940 Federally qualified health center Operational/Managerial Control (100%) May 1, 2018
Clarksville Behavioral HealthClarksville, AR, CCN 041987 Federally qualified health center 5% Or Greater Indirect Ownership Interest Sep 20, 2021
River Valley Primary Care ServicesCoal Hill, AR, CCN 041000 Federally qualified health center Operational/Managerial Control (100%) Dec 6, 2021

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1952349003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9755 W STATE HIGHWAY 22",
            "address_2": "P.O. BOX 130",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729519000",
            "telephone_number": "479-635-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9755 W STATE HIGHWAY 22",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "72951",
            "telephone_number": "479-431-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY PRIMARY CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-431-2057",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156152631",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770106649",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156966749",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ratcliff, AR

Sources for this page

Verify at the official NPI Registry.