NPIMap

Organization Active NPI

Ascension Sacred Heart Gulf

Doing business as Ascension Medical Group Sacred Heart Gulf

  • Rural Health Clinic/Center
  • Wewahitchka, FL
National Provider Identifier
1023506532
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ASCENSION SACRED HEART GULF
Doing business as
Ascension Medical Group Sacred Heart Gulf
Practice address
805 Highway 22
Wewahitchka, FL 32465-3237
Phone
(850) 568-1053
Fax
(850) 568-1140
NPI assigned
Apr 30, 2018
Last updated
Mar 19, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SACRED HEART HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miranda Hemm
Title
Enrollment Manager
Phone
(904) 450-6004

Specialties & licenses 1

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

Addresses

Primary practice location

805 Highway 22
Wewahitchka, FL 32465-3237

Mailing address

PO Box 2699
Attn: SHMG/Hpe
Pensacola, FL 32513-2699
Phone (850) 568-1053

Other names 1

  • Ascension Medical Group Sacred Heart Gulf Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180516000289 FL Part A Provider - Rural Health Clinic 9830231034 Practice locations: Wewahitchka, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023506532. Details of each certification follow.

Rural health clinic certification: CCN 108500

Legal name
ASCENSION SACRED HEART GULF
Doing business as
ASCENSION MEDICAL GROUP SACRED HEART GULF
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 13, 2019
Last certification
May 13, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 27, 2009 in FL
Enrollment address
805 West Hwy 22
Wewahitchka, FL 32465-3237
Related CCNs
100313

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2059136Sacred Heart Medical Group805 Hwy 22, Wewahitchka, FL 32465Certificate of waiverMay 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ascension Sacred Heart Gulf10 organizations share this tax ID, including this one
Part of
Sacred Heart Emerg Phys

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Miranda Hemm Individual W-2 Managing Employee May 1, 2017
Sacred Heart Health System Inc Organization, Pensacola, FL Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2012 100%
Justin H Labrato Individual Corporate OfficerVP Jul 1, 2012
W-2 Managing Employee Jul 1, 2012
Ascension Sacred Heart Gulf Organization, Port St Joe, FL Corporation, Non-profit Operational/Managerial Control Feb 1, 2012 100%

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ascension Sacred Heart GulfPort St Joe, FL, CCN 10U313 Hospital 5% Or Greater Direct Ownership Interest Mar 15, 2010
Ascension Sacred Heart GulfApalachicola, FL, CCN 103452 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012
Ascension Medical Group Sacred Heart GulfPort St Joe, FL, CCN 103461 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 7

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1023506532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "address_2": "ATTN: SHMG/HPE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-568-1053",
            "fax_number": "850-568-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 HIGHWAY 22",
            "city": "WEWAHITCHKA",
            "state": "FL",
            "postal_code": "324653237",
            "telephone_number": "850-568-1053",
            "fax_number": "850-568-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION SACRED HEART GULF",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SACRED HEART HEALTH SYSTEM, INC.",
        "enumeration_date": "2018-04-30",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "HEMM",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "904-450-6004"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Medical Group Sacred Heart Gulf",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wewahitchka, FL

Sources for this page

Verify at the official NPI Registry.