NPIMap

Organization Active NPI

Baxter County Regional Hospital, Inc

Doing business as Baxter Regional Medical Center

  • Psychiatric Hospital Unit
  • Mountain Home, AR
National Provider Identifier
1972549038
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
BAXTER COUNTY REGIONAL HOSPITAL, INC
Doing business as
Baxter Regional Medical Center
Practice address
624 Hospital Dr
Mountain Home, AR 72653-2955
Phone
(870) 508-1000
Fax
(870) 508-1651
NPI assigned
Jun 20, 2006
Last updated
Nov 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Authorized official

Name
Debra Henry
Title
Cfo
Phone
(870) 508-1003

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X AR3827 AR
Psychiatric Hospital Unit 273R00000X AR Primary

Addresses

Primary practice location

624 Hospital Dr
Mountain Home, AR 72653-2955

Mailing address

624 Hospital Dr
Mountain Home, AR 72653-2955
Phone (870) 508-1000

Other identifiers 1

IdentifierTypeStateIssuer
101001105MedicaidAR

Other names 1

  • Baxter Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060907000579 AR Part A Provider - Hospital 3274420971 Practice locations: Mountain Home, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972549038. Details of each certification follow.

Hospital certification: CCN 04S027

Legal name
BAXTER COUNTY REGIONAL HOSPITAL INC
Doing business as
BAXTER HEALTH
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1963 in AR
Enrollment address
624 Hospital Dr
Mountain Home, AR 72653-2955
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Baxter County Reg Hosp Inc40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

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

View all 39

Member organizations 14

Organizations listed as members of this organization in the National Provider Directory.

View all 14

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Rondell Peterson Individual Corporate Director Jun 1, 2007
Debra Henry Individual Corporate DirectorCfo Jan 1, 2017
Richard White Individual Corporate Director Jan 1, 2007
Lincoln a Godfrey Individual W-2 Managing Employee Jan 1, 2007
Clark Fletcher Individual Corporate Director Jan 1, 2006
Steve Luelf Individual Corporate Director Jan 1, 2007
Lucinda Crow Individual Corporate DirectorContract System Analyst Jul 12, 2015
Rosalyn Blagg Individual Corporate Director Jan 1, 2007
Nicole Vaccarella Individual Corporate DirectorVP/General Councel Jan 1, 2017

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Baxter HealthMountain Home, AR, CCN 040027 Hospital Operational/Managerial Control Nov 1, 1966
Baxter Health Family Clinic at Calico RockCalico Rock, AR, CCN 048559 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2025
Baxter Health Family ClinicMountain Home, AR, CCN 048558 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2025
Baxter Health Family Clinic at MelbourneMelbourne, AR, CCN 048555 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025
Baxter Health Family Clinic at Mountain ViewMountain View, AR, CCN 048556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025
Baxter Health Market Street Family ClinicMountain Home, AR, CCN 048557 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025

Owned or controlled facilities with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1972549038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532955",
            "telephone_number": "870-508-1000",
            "fax_number": "870-508-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532955",
            "telephone_number": "870-508-1000",
            "fax_number": "870-508-1651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAXTER COUNTY REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-508-1003"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "AR",
            "license": "AR3827",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101001105",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home, AR

Sources for this page

Verify at the official NPI Registry.