Yes
Baptist Health Medical Center - Little Rock
9601 Baptist Health Drive
Little Rock, AR 72205
DSH040114A | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Sleep Disorder Center | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114B | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Breast Center | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114C | Child | DSH | Baptist Health Medical Center - Little Rock | Kidney Transplant | 9500 Kanis Road | Little Rock | AR | Terminated |
DSH040114D | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Heart Transplant | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114E | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Eye Center | 9800 Baptist Health Drive | Little Rock | AR | Active |
DSH040114G | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Arkansas Cardiology Clinic | 9501 Baptist Health Drive Suite 600 | Little Rock | AR | Active |
DSH040114J | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Infusion Therapy | 9600 Baptist Health Drive Suite 330 | Little Rock | AR | Terminated |
DSH040114K | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | MRI | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114L | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Vein Center | 9501 Baptist Health Drive Suite 830 | Little Rock | AR | Terminated |
DSH040114M | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Pediatric Afterhour Clinic | 9601 Baptist Health Drive | Little Rock | AR | Terminated |
DSH040114N | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | VAD | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114P | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | BAPTIST HEALTH / Outpatient Imaging Center | 9101 KANIS RD | LITTLE ROCK | AR | Active |
DSH040114Q | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | BH Heart Inst-Valve Clinic | 9500 Kanis Road | Little Rock | AR | Terminated |
DSH040114R | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | BH Employee Clinic | 9600 Baptist Health Drive | Little Rock | AR | Active |
DSH040114S | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | BH Gastroenterology Center - BH Gastroenterology Center | 9501 Baptist Health Drive | Little Rock | AR | Active |
DSH040114T | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Heart Failure Clinic - Heart Failure Clinic | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114U | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | LR INFUSION THERAPY - LR INFUSION THERAPY | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114V | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Oncology Clinic - Oncology Clinic | 9500 Kanis Road | Little Rock | AR | Active |
DSH040114W | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Neurology Clinic - Neurology Clinic | 9600 Baptist Health Drive | Little Rock | AR | Active |
DSH040114X | Child | DSH | BAPTIST HEALTH MEDICAL CENTER - LR | Gastroenterology Clinic - Gastroenterology Clinic | 9501 Baptist Health Drive | Little Rock | AR | Active |
Details | Last Recertification Date | Update | Recertification | 9/13/2023 11:28:08 AM | 9/3/2024 11:09:02 AM | 9/3/2024 11:09 AM |
Details | Last Recertification Date | Update | Recertification | 9/12/2022 12:30:51 PM | 9/13/2023 11:28:08 AM | 9/13/2023 11:28 AM |
Details | Last Recertification Date | Update | Recertification | 9/3/2021 4:45:33 PM | 9/12/2022 12:30:51 PM | 9/12/2022 12:30 PM |
Details | Last Recertification Date | Update | Recertification | | 9/3/2021 4:45:33 PM | 9/3/2021 4:45 PM |
Details | State | Update | | Approved | Active | 1/1/2021 12:01 AM |
Contacts | Signed By | Insert | New Registration | | Beaulieu, Brent
CFO
Baptist Health
5012022017 | 10/21/2020 8:10 AM |
Details | 340B ID | Update | New Registration | | DSH040114T | 10/21/2020 8:10 AM |
Details | Entity Subname | Update | New Registration | Heart Failure Clinic | Heart Failure Clinic - Heart Failure Clinic | 10/21/2020 8:10 AM |
Dates | Participating Approval Date | Update | New Registration | | 10/21/2020 8:10:17 AM | 10/21/2020 8:10 AM |
Details | State | Update | New Registration | Pending | Approved | 10/21/2020 8:10 AM |
Dates | Signed By Date | Update | New Registration | | 10/20/2020 6:48:16 PM | 10/21/2020 8:10 AM |
Dates | Start Date | Update | New Registration | | 1/1/2021 12:00:00 AM | 10/21/2020 8:10 AM |
Addresses | Main Address | Insert | New Registration | |
9500 Kanis Road
Suite 310
Little Rock, AR 72205 | 10/14/2020 4:40 PM |
Addresses | Billing Address | Insert | New Registration | | Baptist Health Medical Center - Little Rock
9601 Baptist Health Drive
Little Rock, AR 72205 | 10/14/2020 4:40 PM |
Addresses | Shipping Address | Insert | New Registration | | Baptist Health Medical Center - Little Rock
9601 Baptist Health Drive
Little Rock, AR 72205 | 10/14/2020 4:40 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/14/2020 4:40 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 104304105 | 10/14/2020 4:40 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | AR | 10/14/2020 4:40 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1043240682 | 10/14/2020 4:40 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | AR | 10/14/2020 4:40 PM |
Contacts | Primary Contact | Insert | New Registration | | Jaeger, Stefanie
Sr. Reimbursement Specialist
Baptist Health
5012021813 | 10/14/2020 4:40 PM |
Contacts | Authorizing Official | Insert | New Registration | | Beaulieu, Brent
CFO
Baptist Health
5012022017 | 10/14/2020 4:40 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | Grant Number | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | 340B ID | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/14/2020 4:40 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | Medicare Provider Number | Insert | New Registration | | 040114 | 10/14/2020 4:40 PM |
Details | Entity Name | Insert | New Registration | | BAPTIST HEALTH MEDICAL CENTER - LR | 10/14/2020 4:40 PM |
Details | NOFO Number | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | Program Code | Insert | New Registration | | DSH | 10/14/2020 4:40 PM |
Details | Entity Subname | Insert | New Registration | | Heart Failure Clinic | 10/14/2020 4:40 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Details | State | Insert | New Registration | | Pending | 10/14/2020 4:40 PM |
Dates | Registration Date | Insert | New Registration | | 10/14/2020 4:40:54 PM | 10/14/2020 4:40 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Dates | Start Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/14/2020 4:40 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/14/2020 4:40 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/14/2020 4:40 PM |