CHICOT MEMORIAL MEDICAL CENTER WOMENS CLINIC
NPI 1104238179
Clinic/Center in Lake Village, AR
About Chicot Memorial Medical Center Womens Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CHICOT MEMORIAL MEDICAL CENTER WOMENS CLINIC (NPI 1104238179) is a healthcare organization registered as a clinic/center in Lake Village, Arkansas and active in the NPI registry since May 2014. The organization lists Susan Vaughn, Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 5
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Chicot Memorial Medical Center Womens Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Chicot Memorial Medical Center Womens Clinic, which bills Medicare for the services they deliver. Of these, 6 practice within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 5
Clinicians, nearest first (12)
Washington, DC 20019
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Chicot Memorial Medical Center's NPI number?
The NPI number for Chicot Memorial Medical Center is 1104238179. It was assigned to this organization in the NPPES registry on May 27, 2014. The provider is also known as Chicot Memorial Medical Center Womens Clinic.
Where is Chicot Memorial Medical Center located?
Chicot Memorial Medical Center is located at 2729 Hwy 65 & 82 S, Lake Village, AR 71653. The listed phone number is (870) 265-5351.
What is Chicot Memorial Medical Center's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Chicot Memorial Medical Center enrolled in Medicare?
Yes. Chicot Memorial Medical Center is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Chicot Memorial Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians in 5 Medicare specialties reassign their Medicare billing to Chicot Memorial Medical Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (4), Certified Registered Nurse Anesthetist (CRNA) (3) and Family Practice (3). Of these, 6 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Chicot Memorial Medical Center was last updated on July 9, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Chicot Memorial Medical Center Womens Clinic · NPI 1104238179
Clinic/Center organization in Lake Village, Arkansas. Organization record, active in the CMS NPPES registry since May 27, 2014.
## Identity
- **NPI:** 1104238179 (Entity type: Organization)
- **Enumerated:** May 27, 2014
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Legal business name:** Chicot Memorial Medical Center
- **Organization subpart:** No
- **Authorized official:** Susan Vaughn, CFO
## Practice location
- **Address:** 2729 HWY 65 & 82 S, Lake Village, AR 71653-6136
- **Phone:** (870) 265-5351 · **Fax:** (870) 265-2091
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 12 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Certified Registered Nurse Anesthetist (CRNA) (3), Family Practice (3); 6 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 9, 2015
- **Other identifiers:** Other 04-1328; Other 04-Z328; Medicare PIN 04-1328; and 2 more
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Source: [NPI Profile](https://npiprofile.com/npi/1104238179) · Data from the CMS NPPES public registry.