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River Valley Primary Care Services

Organization Active NPI Federally Qualified Health Center (FQHC) · Waldron, AR

NPI 1992212013 · NPPES record last updated Feb 1, 2021

Key facts

NPI
1992212013
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
RIVER VALLEY PRIMARY CARE SERVICES
Practice address
2074 Rice Road
Waldron, AR 72958
Phone
(479) 635-5300
NPI assigned
Jan 10, 2018
Organization subpart
No

Authorized official

Name
Jerome J White
Title
Executive Director
Phone
(479) 635-0091

Owners & managing parties with NPI records 14

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 13

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

Other NPIs with the same Medicare PAC ID 14

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

Corporate family (same tax ID) 19

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

Facilities with the same owner 2

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

Practitioners 39

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

View all 39

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
04D2142818Waldron Family Clinic
2074 Rice Road, Waldron, AR 72958		Provider-performed microscopyJan 18, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AR

Federally qualified health center certification: CCN 041940

Legal name
RIVER VALLEY PRIMARY CARE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2018
Last certification
Jun 4, 2018
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 29, 2003 in AR
Enrollment address
2074 Rice Road
Waldron, AR 72958-7435

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
River Valley Primary Care Services
Organization · Ratcliff, AR
Corporation, Non-profit 		Operational/Managerial Control May 1, 2018 100%
Mark Luerssen
Individual 		Corporate Director
Board Member		 Nov 25, 2005 5%
Robert Redding
Individual 		Corporate Director
Board Member		 Aug 25, 2013 5%
Greg Swartz
Individual 		Corporate Director
Board Member		 May 24, 2009 5%
Sheila Peck
Individual 		Corporate Director
Board Member		 Dec 1, 2022
Gary O'Neal
Individual 		Corporate Director
Board Member		 Apr 4, 2005 5%
Jerome J White
Individual 		Corporate Director
Executive Director		 Apr 4, 2005 5%
W-2 Managing Employee
Executive Director		 Apr 4, 2005 5%
Bobby G McCartney
Individual 		Corporate Director
Board Member		 Jul 27, 2016 5%
Mary Howard
Individual 		Corporate Director
Board Member		 Jul 24, 2006 5%
Jessica Brown
Individual 		Corporate Director
Board Member		 Dec 12, 2018
Laura Bryant
Individual 		Corporate Director
Board Member		 Jun 1, 2021
Carmelita Adams
Individual 		Corporate Director
Board Member		 Jul 11, 2011 5%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Clarksville Behavioral Health
Clarksville, AR · CCN 041987		 Federally qualified health center 5% Or Greater Indirect Ownership Interest Sep 20, 2021
River Valley Primary Care Services
Coal Hill, AR · CCN 041000		 Federally qualified health center Operational/Managerial Control (100%) Dec 6, 2021

Medicare enrollment records

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…
O20180604001516 AR Part a Provider - Federally Qualified Health Center (FQHC) 0042274276 Practice locations: Waldron, AR

National Provider Directory

Tax ID family
River Valley Primary Care Services (20 organizations share this tax ID)

Locations

920 S Highway 45
Fort Smith, AR 72916
Phone (479) 255-6095

Specialties & licenses

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

Addresses

Primary practice location

2074 Rice Road
Waldron, AR 72958

Mailing address

PO Box 130
Ratcliff, AR 72951-0130
Phone (479) 635-0091

Other names

  • Waldron Family Clinic Doing business as

Other providers in Waldron, AR

All providers in Waldron, AR · Federally Qualified Health Center (FQHC) in Arkansas

Sources for this page

Verify at the official NPI Registry.