NUTT-WALLEY CLINIC OF DALLAS COUNTY MEDICAL CENTER
NPI 1508364241
Clinic/Center - Rural Health in Fordyce, AR
About Nutt-walley Clinic Of Dallas County Medical Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NUTT-WALLEY CLINIC OF DALLAS COUNTY MEDICAL CENTER (NPI 1508364241) is a healthcare organization registered as a rural health in Fordyce, Arkansas and active in the NPI registry since January 2018. The organization lists Kenneth E Sanders, Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
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)
Nutt-walley Clinic Of Dallas County Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
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
18Medicare enrollment records show 18 clinicians reassign Medicare billing to Nutt-Walley Clinic Of Dallas County Medical Center, which bills Medicare for the services they deliver. Of these, 7 practice within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 5
Clinicians, nearest first (18)
Birmingham, AL 35209
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 Board Of Governors Of Dallas County Medical Center's NPI number?
The NPI number for Board Of Governors Of Dallas County Medical Center is 1508364241. It was assigned to this organization in the NPPES registry on January 29, 2018. The provider is doing business as Nutt-Walley Clinic Of Dallas County Medical Center.
Where is Board Of Governors Of Dallas County Medical Center located?
Board Of Governors Of Dallas County Medical Center is located at 110 N Clifton St, Fordyce, AR 71742. The listed phone number is (870) 352-3525.
What is Board Of Governors Of Dallas County Medical Center's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Board Of Governors Of Dallas County Medical Center enrolled in Medicare?
Yes. Board Of Governors Of Dallas County Medical Center is registered in the Medicare PECOS enrollment system.
When is Board Of Governors Of Dallas County Medical Center'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 February 28, 2027. 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 Board Of Governors Of Dallas County Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 18 clinicians in 5 Medicare specialties reassign their Medicare billing to Board Of Governors Of Dallas County 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 Family Practice (6), Nurse Practitioner (6) and Emergency Medicine (2). Of these, 7 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Board Of Governors Of Dallas County Medical Center 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 Board Of Governors Of Dallas County Medical Center 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 Board Of Governors Of Dallas County Medical Center was last updated on January 29, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.
# Nutt-Walley Clinic Of Dallas County Medical Center · NPI 1508364241
Rural Health organization in Fordyce, Arkansas. Organization record, active in the CMS NPPES registry since January 29, 2018.
## Identity
- **NPI:** 1508364241 (Entity type: Organization)
- **Enumerated:** January 29, 2018
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Legal business name:** Board Of Governors Of Dallas County Medical Center
- **Organization subpart:** No
- **Authorized official:** Kenneth Sanders, ADMINISTRATOR
## Practice location
- **Address:** 110 N CLIFTON ST, Fordyce, AR 71742-3025
- **Phone:** (870) 352-3525 · **Fax:** (870) 352-3533
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Arkansas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 18 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (6), Nurse Practitioner (6), Emergency Medicine (2); 7 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 29, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1508364241) · Data from the CMS NPPES public registry.