CONWAY REGIONAL MEDICAL CLINIC-RUSSELLVILLE
NPI 1245729359
Family Medicine in Russellville, AR
About Conway Regional Medical Clinic-russellville NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CONWAY REGIONAL MEDICAL CLINIC-RUSSELLVILLE (NPI 1245729359) is a healthcare organization registered as a family medicine in Russellville, Arkansas and active in the NPI registry since May 2018. The organization holds a CLIA Waiver certificate valid through May 15, 2027 and lists William Pack, Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Conway Regional Medical Clinic-russellville is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
44Medicare enrollment records show 44 clinicians reassign Medicare billing to Conway Regional Medical Clinic-Russellville, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 10 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 7
Nearest to this location (20)
See all 44Source: 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
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 Waiver 04D0468970
Conway Regional Medical Clinic -Russellville · Russellville, 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 Conway Regional Medical Center, Inc's NPI number?
The NPI number for Conway Regional Medical Center, Inc is 1245729359. It was assigned to this organization in the NPPES registry on May 3, 2018. The provider is doing business as Conway Regional Medical Clinic-Russellville.
Where is Conway Regional Medical Center, Inc located?
Conway Regional Medical Center, Inc is located at 108 Skyline Dr, Russellville, AR 72801. The listed phone number is (479) 968-7170.
What is Conway Regional Medical Center, Inc's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Conway Regional Medical Center, Inc enrolled in Medicare?
Yes. Conway Regional Medical Center, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Conway Regional Medical Center, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 44 clinicians in 7 Medicare specialties reassign their Medicare billing to Conway Regional Medical Center, 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 (19), Family Practice (15) and Internal Medicine (6). Of these, 4 practice at this address and 10 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Conway Regional Medical Center, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 04D0468970) is associated with this NPI, valid through May 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Conway Regional Medical Center, 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 Conway Regional Medical Center, 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 Conway Regional Medical Center, Inc was last updated on November 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Conway Regional Medical Clinic-Russellville · NPI 1245729359
Family Medicine organization in Russellville, Arkansas. Organization record, active in the CMS NPPES registry since May 3, 2018.
## Identity
- **NPI:** 1245729359 (Entity type: Organization)
- **Enumerated:** May 3, 2018
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Conway Regional Medical Center, Inc
- **Organization subpart:** No
- **Authorized official:** William Pack, CFO
## Practice location
- **Address:** 108 SKYLINE DR, Russellville, AR 72801-3362
- **Phone:** (479) 968-7170 · **Fax:** (479) 968-7607
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 44 clinicians in 7 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (19), Family Practice (15), Internal Medicine (6); 4 practice at this address and 10 within 10 miles; [full list](https://npiprofile.com/npi/1245729359/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 9, 2023
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1245729359) · Data from the CMS NPPES public registry.