NPIMap

Organization Active NPI

River Valley Primary Care Services

Doing business as Clarksville Behavioral Health

  • Federally Qualified Health Center (FQHC)
  • Clarksville, AR
National Provider Identifier
1982277265
Registry record updated Jul 23, 2021
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
Doing business as
Clarksville Behavioral Health
Practice address
106 N Hill St
Clarksville, AR 72830-2961
Phone
(479) 668-3292
Fax
(479) 668-3293
NPI assigned
Jul 23, 2021
Last updated
Jul 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Authorized official

Name
Jerome J White
Title
Ceo
Phone
(479) 431-2057

Specialties & licenses 1

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

Addresses

Primary practice location

106 N Hill St
Clarksville, AR 72830-2961

Mailing address

PO Box 130
Ratcliff, AR 72951-0130
Phone (479) 431-2057

Other names 1

  • Clarksville Behavioral Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050503001398 AR Part B Supplier - Clinic/Group Practice 0042274276 Receives reassigned benefits from 41 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waldron, AR; Ratcliff, AR; Mulberry, AR; Mountainburg, AR; Lavaca, AR; Lamar, AR; Fort Smith, AR; Coal Hill, AR…
O20211028001187 AR Part A Provider - Federally Qualified Health Center (FQHC) 0042274276 Practice locations: Clarksville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982277265. Details of each certification follow.

Federally qualified health center certification: CCN 041987

Legal name
RIVER VALLEY PRIMARY CARE SERVICES
Doing business as
CLARKSVILLE BEHAVIORAL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 5, 2021
Last certification
Nov 5, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 29, 2003 in AR
Enrollment address
106 North Hill Street
Clarksville, AR 72830-2961

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
Tax ID family
River Vly Primary Care SVCS20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
River Valley Primary Care Services Organization, Clarksville, AR 5% Or Greater Indirect Ownership Interest Sep 20, 2021
Mark Luerssen Individual Corporate DirectorBoard Member Nov 1, 2005
Robert Redding Individual Corporate DirectorBoard Member Aug 1, 2013
Greg Swartz Individual Corporate DirectorTreasurer May 1, 2009
Gary O'Neal Individual Corporate DirectorBoard President Oct 1, 2005
Jerome J White Individual Corporate OfficerCeo77 Sep 29, 2003 100%
W-2 Managing EmployeeCeo Sep 29, 2003 100%
Bobby G McCartney Individual Corporate DirectorBoard Member Jun 1, 2015
Mary Howard Individual Corporate DirectorSecretary Jul 1, 2006
Jessica Brown Individual Corporate DirectorBoard Member Dec 12, 2018
Carmelita Adams Individual Corporate DirectorVice President of Board Jul 1, 2011

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 2

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
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 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1982277265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "RATCLIFF",
            "state": "AR",
            "postal_code": "729510130",
            "telephone_number": "479-431-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N HILL ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728302961",
            "telephone_number": "479-668-3292",
            "fax_number": "479-668-3293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY PRIMARY CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-07-23",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-431-2057"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarksville Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, AR

Sources for this page

Verify at the official NPI Registry.