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Baptist Health Medical Group Inc

Organization Active NPI Rural Health Clinic/Center · Calvert City, KY

NPI 1003384694 · NPPES record last updated Jul 10, 2024

Key facts

NPI
1003384694
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
BAPTIST HEALTH MEDICAL GROUP INC
Practice address
4754 US Highway 62
Calvert City, KY 42029-8456
Phone
(270) 415-7780
Fax
(270) 415-7779
NPI assigned
Nov 13, 2018
Organization subpart
Yes
Parent organization (as reported)
BAPTIST HEALTH MEDICAL GROUP INC

Authorized official

Name
Danyel D Clay
Title
Vice President Revenue Cycle
Phone
(502) 253-4911

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 40

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 40

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities with the same owner 29

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 29

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KY

Rural health clinic certification: CCN B03803

Legal name
BAPTIST HEALTH MEDICAL GROUP INC
Doing business as
CALVERT CITY RURAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 10, 2019
Last certification
Oct 10, 2019
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Jul 21, 2006 in KY
Enrollment address
4754 US Highway 62
Calvert City, KY 42029-8456

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Staci Dawn Farner Rogers
Individual 		Corporate Director Jan 1, 2022
Richard Carrico
Individual 		Corporate Officer Apr 12, 2023
Janet Norton
Individual 		Corporate Officer
Vice President/Chief Legal Offic		 Jan 1, 2013
Frank Purdy
Individual 		Corporate Director Jan 1, 2022
Victoria Buster
Individual 		Corporate Director Jan 1, 2023
Danyel D Clay
Individual 		W-2 Managing Employee Jan 1, 2023
Isaac J Myers
Individual 		Corporate Officer
President		 Jan 10, 2018
Joanne M Berryman
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Daniel P O'Hair
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Baptist Healthcare System Inc
Organization · Louisville, KY
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Apr 19, 2017 100%
Ronald Douglas Reed
Individual 		Corporate Officer
Vice President		 Jan 17, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070228000503 KY Part B Supplier - Clinic/Group Practice 5597867184 Receives reassigned benefits from 1,548 practitioners
40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20190402000414 KY Part a Provider - Rural Health Clinic 5597867184 Practice locations: Calvert City, KY

National Provider Directory

Part of
Baptist Health Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

4754 US Highway 62
Calvert City, KY 42029-8456

Mailing address

1901 Campus PL
Louisville, KY 40299-2308
Phone (502) 253-4911

Other names

  • Calvert City Rural Health Center Doing business as

Other providers in Calvert City, KY

All providers in Calvert City, KY · Rural Health Clinic/Center in Kentucky

Sources for this page

Verify at the official NPI Registry.