Franklin County Board of County Commissioners
Organization Active NPI Rural Health Clinic/Center · Carrabelle, FL
NPI 1033438627 · NPPES record last updated Oct 31, 2024
Key facts
- NPI
- 1033438627
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FRANKLIN COUNTY BOARD OF COUNTY COMMISSIONERS
- Practice address
- 110 NE 5TH St
Carrabelle, FL 32322-3529 - Phone
- (850) 697-2345
- Fax
- (850) 697-2348
- NPI assigned
- May 23, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- FRANKLIN COUNTY BOARD OF COUNTY COMMISSIONERS
Authorized official
- Name
- David Walker
- Title
- Ceo
- Phone
- (850) 653-8853
Owners & managing parties with NPI records 3
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 3
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 34
-
Amanda Marie Pache, APRN
-
Sussete Valdueza, ARNP
-
Patrick F Conrad, MD
-
Dana Omega Whaley, ARNP-C
-
Roy F.C. Parker, PA-C
-
Kristal J Martin, ARNP
-
Adel Abdalla, M.D.
-
Dennis M Burton, M.D.
-
Paul D Hart, MD
-
Cheava L Jacks, MD
-
Philip B. McDonald, M.D.
-
Paul Nicholas Motta, M.D.
-
Abbas A Chamsuddin, M.D.
-
Joshua P Dietzer, M.D.
-
Russell Gerald Gelormini, D.O.
-
Susan A. Gootnick, M.D.
-
Johnathan Charles Hays, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D1097655 | Weems Medical Center East | Certificate of waiver | Mar 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Rural health clinic certification: CCN 103459
- Legal name
- FRANKLIN COUNTY BOARD OF COUNTY COMMISSIONERS
- Doing business as
- WEEMS MEDICAL CENTER EAST
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 9, 2019
- Last certification
- Apr 1, 2019
- Ownership / control type
- 1B
- Organization structure
- Other · Non-profit
- Enrollment address
- 110 NE 5TH St
Carrabelle, FL 32322-3529 - Related CCNs
- 101305
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Franklin County Board of County Commissioners |
5% Or Greater Direct Ownership Interest | Nov 26, 2008 | 100% |
| David Bernard Walker |
Contracted Managing Employee | Jan 1, 2021 | 50% |
| Corporate Officer |
Sep 12, 2019 | 50% | |
| David Bowling |
Corporate Officer |
Jun 1, 2024 | 50% |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| George E Weems Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2006 |
| George E Weems Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2006 |
| Weems Medical Center West |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 23, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110218000010 | FL | Part B Supplier - Clinic/Group Practice | 3274541115 |
Receives reassigned benefits from 8 practitioners 1 other NPI on this enrollment Practice locations: Apalachicola, FL; Carrabelle, FL |
| O20191119000057 | FL | Part a Provider - Rural Health Clinic | 3274541115 | Practice locations: Carrabelle, FL |
National Provider Directory
- Part of
- Franklin County Board of County Commissioners
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
110 NE 5TH St
Carrabelle, FL 32322-3529
Mailing address
135 Avenue G
Apalachicola, FL 32320-1613
Phone (850) 653-8853
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106362400 | Medicaid | FL |
Other names
- Weems Medical Center East
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | SBUSKIRK@WEEMSMEMORIAL.COM | Direct |
Other providers in Carrabelle, FL
- Lionel B Catlin
- County of Franklin Office Clerk Board County Commissioners
- Elizabeth Crossley
- Jonathan Edwin Fountain
- Franklin Canyon Healthcare, Inc.
- Kyron Jerrel Gibson Sr.
- Maria Louise Horan
- Angela Lynn Kennedy
- Maria L. Horan, L.C.S.W., P.a.
- NHC-Op LP
All providers in Carrabelle, FL · Rural Health Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.