WESTSIDE FAMILY CLINIC LLC
NPI 1801587779
Nurse Practitioner - Family in Russellville, AR
About Westside Family Clinic Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WESTSIDE FAMILY CLINIC LLC (NPI 1801587779) is a healthcare organization registered as a family in Russellville, Arkansas and active in the NPI registry since May 2023. The organization holds 2 active CLIA laboratory certificates and lists Jeffrey Bosold, Ceo, 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)
Westside Family Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
10Medicare enrollment records show 10 clinicians reassign Medicare billing to Westside Family Clinic LLC, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 8 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 3
Clinicians, nearest first (10)
Source: 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 Compliance 04D2284065
Westside Family Clinic, LLC · Russellville, ARCertificate of Waiver 04D2340426
Westside Family Clinic Parkway · 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 Westside Family Clinic LLC's NPI number?
The NPI number for Westside Family Clinic LLC is 1801587779. It was assigned to this organization in the NPPES registry on May 19, 2023.
Where is Westside Family Clinic LLC located?
Westside Family Clinic LLC is located at 3812 W Main St, Russellville, AR 72801. The listed phone number is (479) 968-1245.
What is Westside Family Clinic LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Westside Family Clinic LLC enrolled in Medicare?
Yes. Westside Family Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Westside Family Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 10 clinicians in 3 Medicare specialties reassign their Medicare billing to Westside Family Clinic LLC. 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 (8), Family Practice (1) and Registered Dietitian or Nutrition Professional (1). Of these, 6 practice at this address and 8 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Westside Family Clinic LLC 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.
When was this NPI record last updated?
The NPPES record for Westside Family Clinic LLC was last updated on May 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.
# Westside Family Clinic Llc · NPI 1801587779
Family organization in Russellville, Arkansas. Organization record, active in the CMS NPPES registry since May 19, 2023.
## Identity
- **NPI:** 1801587779 (Entity type: Organization)
- **Enumerated:** May 19, 2023
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Jeffrey Bosold, CEO
## Practice location
- **Address:** 3812 W MAIN ST, Russellville, AR 72801-2314
- **Phone:** (479) 968-1245
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 10 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (8), Family Practice (1), Registered Dietitian or Nutrition Professional (1); 6 practice at this address and 8 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 19, 2023
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1801587779) · Data from the CMS NPPES public registry.