JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC
NPI 1104587526
Family Medicine in Monticello, AR
About Jefferson Regional Monticello Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC (NPI 1104587526) is a healthcare organization registered as a family medicine in Monticello, Arkansas and active in the NPI registry since January 2022. The organization holds 2 active CLIA laboratory certificates and lists Shayla Robinson, Corporate Compliance Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jefferson Regional Monticello Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
106Medicare enrollment records show 106 clinicians reassign Medicare billing to Jefferson Regional Monticello Medical Clinic, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 22
Nearest to this location (20)
See all 106Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 2
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Accreditation 04D0465417
Jefferson Regional Monticello Medical Clinic · Monticello, ARCertificate of Waiver 04D2176842
Jefferson Regional Monticello Medical Clinic 2 · Monticello, ARFrequently 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 Jefferson Hospital Association, Inc's NPI number?
The NPI number for Jefferson Hospital Association, Inc is 1104587526. It was assigned to this organization in the NPPES registry on January 7, 2022. The provider is also known as Jefferson Regional Monticello Medical Clinic.
Where is Jefferson Hospital Association, Inc located?
Jefferson Hospital Association, Inc is located at 906 Roberts Drive Suite B, Monticello, AR 71655. The listed phone number is (870) 367-1461.
What is Jefferson Hospital Association, Inc's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Jefferson Hospital Association, Inc enrolled in Medicare?
Yes. Jefferson Hospital Association, Inc is registered in the Medicare PECOS enrollment system.
When is Jefferson Hospital Association, Inc's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Arkansas, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Jefferson Hospital Association, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 106 clinicians in 22 Medicare specialties reassign their Medicare billing to Jefferson Hospital Association, Inc. 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 (21), Family Practice (15) and Internal Medicine (11). Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Jefferson Hospital Association, Inc hold CLIA laboratory certificates?
Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
What insurance does Jefferson Hospital Association, Inc accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Jefferson Hospital Association, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jefferson Hospital Association, Inc was last updated on April 1, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Jefferson Regional Monticello Medical Clinic · NPI 1104587526
Family Medicine organization in Monticello, Arkansas. Organization record, active in the CMS NPPES registry since January 7, 2022.
## Identity
- **NPI:** 1104587526 (Entity type: Organization)
- **Enumerated:** January 7, 2022
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Jefferson Hospital Association, Inc
- **Organization subpart:** No
- **Authorized official:** Shayla Robinson, CORPORATE COMPLIANCE OFFICER
## Practice location
- **Address:** 906 ROBERTS DRIVE, SUITE B, Monticello, AR 71655-5724
- **Phone:** (870) 367-1461
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Arkansas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 106 clinicians in 22 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (21), Family Practice (15), Internal Medicine (11); 4 practice at this address and 5 within 10 miles; [full list](https://npiprofile.com/npi/1104587526/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 1, 2022
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104587526) · Data from the CMS NPPES public registry.