THE RIDGE MEDICAL CLINIC
NPI 1104506617
Nurse Practitioner - Family in Forrest City, AR
About The Ridge Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
THE RIDGE MEDICAL CLINIC (NPI 1104506617) is a healthcare organization registered as a family in Forrest City, Arkansas and active in the NPI registry since July 2023. The organization lists Deanna Kay Michaelis, Full Independent Practice, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
The Ridge Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to The Ridge Medical Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
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 The Ridge Medical Clinic's NPI number?
The NPI number for The Ridge Medical Clinic is 1104506617. It was assigned to this organization in the NPPES registry on July 19, 2023.
Where is The Ridge Medical Clinic located?
The Ridge Medical Clinic is located at 114 N Washington St, Forrest City, AR 72335. The listed phone number is (870) 317-5676.
What is The Ridge Medical Clinic's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is The Ridge Medical Clinic enrolled in Medicare?
Yes. The Ridge Medical Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through The Ridge Medical Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to The Ridge Medical Clinic. 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for The Ridge Medical Clinic was last updated on July 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# The Ridge Medical Clinic · NPI 1104506617
Family organization in Forrest City, Arkansas. Organization record, active in the CMS NPPES registry since July 19, 2023.
## Identity
- **NPI:** 1104506617 (Entity type: Organization)
- **Enumerated:** July 19, 2023
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Deanna Michaelis, FULL INDEPENDENT PRACTICE
## Practice location
- **Address:** 114 N WASHINGTON ST, Forrest City, AR 72335-3327
- **Phone:** (870) 317-5676
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 19, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1104506617) · Data from the CMS NPPES public registry.