RIVER VALLEY PRIMARY CARE — NPI 1679563712 (Licensed & Credentialed Suppliers

CMS-1500 Box 24J / 33a • NPI

1679563712

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

333600000X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy

Box 32 Service Location & ZIP+4

442 N MAIN ST, MULBERRY, AR, 72947-8574

✓ 9-Digit EDI 837 ZIP+4 (72947-8574)

Practice Phone & Referral Fax

(479) 997-8033

Fax: (479) 997-1581

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1679563712 (RIVER VALLEY PRIMARY CARE) 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	`1679563712` (NPI-2 Organization / Facility)
Provider / Legal Name	RIVER VALLEY PRIMARY CARE
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy NUCC Code: `333600000X` (Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	442 N MAIN ST, MULBERRY, AR, 72947-8574
Practice Telephone / Fax	Tel: (479) 997-8033 \| Fax: (479) 997-1581
Administrative Mailing Address	PO BOX 130, RATCLIFF, AR, 72951
Enumeration & Last Sync	Enumerated: 2005-10-27 \| CMS Record Updated: 2022-09-08
Authorized Official	JEROME WHITE (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

442 N MAIN ST, MULBERRY, AR, 72947-8574

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Plain-English Taxonomy & CMS Crosswalk (333600000X)

What Does Taxonomy Code 333600000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 333600000X translates to:
"Licensed & Credentialed Suppliers — Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (RIVER VALLEY PRIMARY CARE)

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
`333600000X` — Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy	State: AR \| License: `041036A` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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RIVER VALLEY PRIMARY CARE (NPI #1679563712)