COUNTRYSIDE MANOR LLC — NPI 1275673642 (Licensed & Credentialed Nursing and Custodial Care Facilities

CMS-1500 Box 24J / 33a • NPI

1275673642

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

313M00000X (CMS A3[10])

Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility

Box 32 Service Location & ZIP+4

300 S THOMPSON RD, LAMAR, AR, 72846-9423

✓ 9-Digit EDI 837 ZIP+4 (72846-9423)

Practice Phone & Referral Fax

(479) 754-2052

Fax: (479) 754-5745

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1275673642 (COUNTRYSIDE MANOR LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1275673642` (NPI-2 Organization / Facility)
Provider / Legal Name	COUNTRYSIDE MANOR LLC
Plain-English Specialty	Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility NUCC Code: `313M00000X` (Nursing Facility/Intermediate Care Facility)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	300 S THOMPSON RD, LAMAR, AR, 72846-9423
Practice Telephone / Fax	Tel: (479) 754-2052 \| Fax: (479) 754-5745
Administrative Mailing Address	300 S THOMPSON RD, LAMAR, AR, 72846-9423
Enumeration & Last Sync	Enumerated: 2007-02-07 \| CMS Record Updated: 2008-02-19
Authorized Official	JUSTIN PRICE (Member)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

300 S THOMPSON RD, LAMAR, AR, 72846-9423

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Plain-English Taxonomy & CMS Crosswalk (313M00000X)

What Does Taxonomy Code 313M00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 313M00000X translates to:
"Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility"

CMS-1500 Medicare Specialty Crosswalk: CMS Code A3[10] (Other Nursing Facility)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nursing Facility/Intermediate Care Facility for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (COUNTRYSIDE MANOR LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`313M00000X` — Nursing Facility/Intermediate Care Facility Plain English: Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility	State: AR \| License: `119695311` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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COUNTRYSIDE MANOR LLC (NPI #1275673642)