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CHICOT MEMORIAL MEDICAL CENTER
NPI 1902121494
Emergency Medicine in Lake Village, AR

Active since March 29, 2010
2729 HWY 65 & 82 S, LAKE VILLAGE, AR 71653(870) 265-5351(870) 265-2091 Get Directions Write a Review

NPPES record last updated: June 25, 2015. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Chicot Memorial Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHICOT MEMORIAL MEDICAL CENTER (NPI 1902121494) is a healthcare organization registered as an emergency medicine in Lake Village, Arkansas and active in the NPI registry since March 2010. The organization lists Susan Vaughn, Cfo, as its authorized official.

NPPES Registry Identity

NPI1902121494
Entity TypeOrganization
Primary Taxonomy207P00000X
Legal Business NameCHICOT MEMORIAL MEDICAL CENTER
Location Address2729 HWY 65 & 82 SLake Village, AR 71653-6136
Mailing Address2729 Hwy 65 & 82 SLake Village, AR 71653-6136 · (870) 265-5351 · Fax (870) 265-2091
Phone(870) 265-5351
Fax(870) 265-2091
Organization SubpartYes
Authorized OfficialSusan VaughnCfo · (870) 265-5351
Enumeration DateMarch 29, 2010
Last NPPES UpdateJune 25, 2015
✔ NPI 1902121494 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in AR · AR4386
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
2729 HWY 65 & 82 S, Lake Village, AR 71653
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Other Identifiers 2

Medicaid182738002AR
Medicare PIN5G619

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Chicot Memorial Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Chicot Memorial Medical Center, which bills Medicare for the services they deliver. Of these, 5 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Christopher Johnson, FNP-BC
Nurse Practitioner
NPI 1578945770
2918 LOUIS SESSIONS ST
Lake Village, AR 71653
(870) 265-5343
✔ PECOS✔ Accepts Medicare3.7 mi
Michael Mayfield, M.D.
General Surgery
NPI 1306894803
2729 S HIGHWAY 65 82
Lake Village, AR 71653
(870) 265-9364
✔ PECOS✔ Accepts Medicare3.7 mi
Jo Anne Gregory, MD
Family Practice
NPI 1346252681
2918 LOUIS SESSIONS ST
Lake Village, AR 71653
(870) 265-5343
✔ PECOS✔ Accepts Medicare3.8 mi
James Wright, DO
Family Practice
NPI 1053390781
2918 LOUIS SESSIONS STREET
Lake Village, AR 71653
(870) 265-5343
✔ PECOS✔ Accepts Medicare3.8 mi
Nathan Gladden, NP
Nurse Practitioner
NPI 1619545829
103 WOOD DUCK LN
Lake Village, AR 71653
(870) 538-7225
✔ PECOS✔ Accepts Medicare6.8 mi
Roy Holloway, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1639106479
1813A 6TH ST
Bay City, TX 77414
(870) 866-0441
✔ Accepts Medicare409 mi

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 Chicot Memorial Medical Center's NPI number?

The NPI number for Chicot Memorial Medical Center is 1902121494. It was assigned to this organization in the NPPES registry on March 29, 2010.

Where is Chicot Memorial Medical Center located?

Chicot Memorial Medical Center is located at 2729 Hwy 65 & 82 S, Lake Village, AR 71653. The listed phone number is (870) 265-5351.

What is Chicot Memorial Medical Center's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Chicot Memorial Medical Center enrolled in Medicare?

Yes. Chicot Memorial Medical Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Chicot Memorial Medical Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians reassign their Medicare billing to Chicot Memorial Medical Center, in Certified Registered Nurse Anesthetist (CRNA), Family Practice, General Surgery and Nurse Practitioner. 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. Of these, 5 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Chicot Memorial Medical Center was last updated on June 25, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.