NPIMap

Organization Active NPI

Jefferson Hospital Assn, Inc.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Pine Bluff, AR
National Provider Identifier
1982940433
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
C6122 Issued in AR
Legal business name
JEFFERSON HOSPITAL ASSN, INC.
Practice address
1609 W 40TH Ave
Suite 403
Pine Bluff, AR 71603-6319
Phone
(870) 541-0668
Fax
(870) 541-0083
NPI assigned
Jan 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Authorized official

Name
Walter E. Johnson
Title
Ceo
Phone
(870) 541-7269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X C6122 AR Primary

Addresses

Primary practice location

1609 W 40TH Ave
Suite 403
Pine Bluff, AR 71603-6319

Mailing address

PO Box 2320
Pine Bluff, AR 71613-2320
Phone (870) 541-5981

Other names 1

  • South Arkansas Cardiovascular Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040106000512 AR Part B Supplier - Clinic/Group Practice 8123927431 Receives reassigned benefits from 105 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pine Bluff, AR; Sheridan, AR; Star City, AR; Stuttgart, AR; Warren, AR; White Hall, AR; Crossett, AR; De Witt, AR…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Regional Med15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

733 Roberts Dr
#2
Monticello, AR 71655
Phone 87046047634763

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1982940433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2320",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716132320",
            "telephone_number": "870-541-5981",
            "fax_number": "870-541-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 403",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036319",
            "telephone_number": "870-541-0668",
            "fax_number": "870-541-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON HOSPITAL ASSN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-02",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-541-7269"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "AR",
            "license": "C6122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Arkansas Cardiovascular Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.