NPIMap

White River Health System, Inc.

Organization Active NPI Rural Health Clinic/Center · Batesville, AR

NPI 1962878207 · NPPES record last updated Aug 29, 2024

Key facts

NPI
1962878207
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
WHITE RIVER HEALTH SYSTEM, INC.
Practice address
409 Virginia Dr
Batesville, AR 72501-7329
Phone
(870) 793-5356
Fax
(870) 793-7017
NPI assigned
Aug 20, 2015
Organization subpart
No

Authorized official

Name
Shawna Baxter
Title
Provider Enrollment Specialist
Phone
(870) 262-5545

Other NPIs on the same Medicare enrollment 1

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

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

Facilities with the same owner 16

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 29

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

View all 29

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
04D0468211White River Health Family Care
409 Virginia Dr, Batesville, AR 72501		Certificate of waiverOct 26, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in AR

Rural health clinic certification: CCN 048539

Legal name
WHITE RIVER HEALTH SYSTEM, INC.
Doing business as
WHITE RIVER HEALTH FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 23, 2023
Last certification
Aug 23, 2023
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Aug 17, 1999 in AR
Enrollment address
409 Virginia Dr
Batesville, AR 72501
Related CCNs
040119

All disclosed owners & managing parties 14

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

NameRoleSinceShare
White River Health System, Inc.
Organization · Batesville, AR
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Feb 1, 2023 100%
Steve Case
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Philip Brissey
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Rick Elumbaugh
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Paula Terrell
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Robert McIntire
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Jason Taylor
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Tina Wheelis
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Jeff Showalter
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Kevin S Rose
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Randy Cross
Individual 		Corporate Officer
Board Member		 Feb 1, 2023
Heather Billingsley
Individual 		W-2 Managing Employee
Contract Compliance Specialist		 Jan 1, 2023
Robert Wright
Individual 		Corporate Officer
Administrator		 Jan 1, 2023
Corporate Director
Administrator		 Jan 1, 2023
W-2 Managing Employee
Administrator		 Jan 1, 2023
William Tyler Fowlkes
Individual 		Corporate Officer
Board Member		 Feb 1, 2023

All facility ownership & control disclosures 16

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

FacilityTypeRoleSince
White River Medical Center
Batesville, AR · CCN 040119		 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 31, 1976
Jan 31, 1976
Stone County Medical Center
Mountain View, AR · CCN 041310		 Hospital Operational/Managerial Control Jan 1, 2008
Stone County Medical Center
Mountain View, AR · CCN 04Z310		 Hospital 5% Or Greater Direct Ownership Interest Apr 1, 1999
White River Medical Center
Batesville, AR · CCN 04S119		 Hospital Operational/Managerial Control Dec 21, 2007
White River Medical Center Rehabilitation Unit
Batesville, AR · CCN 04T119		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Midway Medical Clinic
Cherokee Village, AR · CCN 043981		 Rural health clinic Operational/Managerial Control (100%) Sep 10, 2010
Melbourne Medical Clinic
Melbourne, AR · CCN 043997		 Rural health clinic Operational/Managerial Control Oct 16, 2007
Drasco Medical Clinic
Drasco, AR · CCN 043455		 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 12, 1996
Cave City Medical Clinic
Cave City, AR · CCN 043982		 Rural health clinic Operational/Managerial Control Nov 19, 1991
Plesant Plains Medical Clinic
Pleasant Plains, AR · CCN 043422		 Rural health clinic Operational/Managerial Control Jul 1, 2006
White River Health Family Care
Mountain View, AR · CCN 043884		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2015
Sugarloaf Medical Clinic
Heber Springs, AR · CCN 043914		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021
White River Health Family Care
Newark, AR · CCN 048540		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Family Care
Southside, AR · CCN 048541		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
White River Health Care Family
Batesville, AR · CCN 048542		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023
White River Health Children'S Clinic
Batesville, AR · CCN 048543		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20151211000254 AR Part B Supplier - Clinic/Group Practice 0143134270 Receives reassigned benefits from 27 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Batesville, AR; Cherokee Village, AR
O20160318001395 AR Part B Supplier - Clinic/Group Practice 0143134270 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Batesville, AR
O20230307000414 AR Part a Provider - Rural Health Clinic 0143134270 Practice locations: Batesville, AR

National Provider Directory

Locations

409 Virginia Dr
#F
Batesville, AR 72501
Phone (870) 793-5356

1301 White Dr
Batesville, AR 72501
Phone (870) 793-5504

1217 Batesville Blvd
Southside, AR 72501
Phone (870) 262-2800

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

409 Virginia Dr
Batesville, AR 72501-7329

Mailing address

1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 793-5356

Other names

  • WHITE RIVER HEALTH FAMILY CARE Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 29, 2024.

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1962878207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 HARRISON ST",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017303",
            "telephone_number": "870-793-5356",
            "fax_number": "870-793-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 VIRGINIA DR",
            "city": "BATESVILLE",
            "state": "AR",
            "postal_code": "725017329",
            "telephone_number": "870-793-5356",
            "fax_number": "870-793-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "870-262-5545"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHITE RIVER HEALTH FAMILY CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WHITE RIVER HEALTH FAMILY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Batesville, AR

All providers in Batesville, AR · Rural Health Clinic/Center in Arkansas

Sources for this page

Verify at the official NPI Registry.