RIVERSIDE MEDICAL CLINIC
NPI 1811206923
Family Medicine in Lake City, AR
About Riverside Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RIVERSIDE MEDICAL CLINIC (NPI 1811206923) is a healthcare organization registered as a family medicine in Lake City, Arkansas and active in the NPI registry since October 2010. The organization lists Tommy Wagner, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
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)
Riverside Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Riverside 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 (7)
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
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 04D2015798
Riverside Medical Clinic · Lake City, 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 Riverside Medical Clinic's NPI number?
The NPI number for Riverside Medical Clinic is 1811206923. It was assigned to this organization in the NPPES registry on October 7, 2010.
Where is Riverside Medical Clinic located?
Riverside Medical Clinic is located at 803 Hwy 18, Lake City, AR 72347. The listed phone number is (870) 237-1055.
What is Riverside Medical Clinic's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Riverside Medical Clinic enrolled in Medicare?
Yes. Riverside Medical Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Riverside Medical Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 3 Medicare specialties reassign their Medicare billing to Riverside 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. The largest specialties are Nurse Practitioner (4), Family Practice (2) and Pediatric Medicine (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Riverside Medical Clinic 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 Riverside Medical Clinic 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 Riverside Medical Clinic was last updated on August 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.
# Riverside Medical Clinic · NPI 1811206923
Family Medicine organization in Lake City, Arkansas. Organization record, active in the CMS NPPES registry since October 7, 2010.
## Identity
- **NPI:** 1811206923 (Entity type: Organization)
- **Enumerated:** October 7, 2010
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Tommy Wagner, OWNER
## Practice location
- **Address:** 803 HWY 18, Lake City, AR 72347-0505
- **Phone:** (870) 237-1055 · **Fax:** (870) 237-1054
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Family Practice (2), Pediatric Medicine (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 2, 2011
- **Other identifiers:** Medicare PIN 5G721 (AR); Medicaid 187113002 (AR)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1811206923) · Data from the CMS NPPES public registry.