NPIMap

Organization Active NPI

Ascension Sacred Heart Gulf

  • Rural Acute Care Hospital
  • Port St Joe, FL
National Provider Identifier
1083941678
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
ASCENSION SACRED HEART GULF
Practice address
3801 E Highway 98
Port St Joe, FL 32456-5318
Phone
(850) 229-5600
Fax
(850) 416-7453
NPI assigned
Nov 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Authorized official

Name
Coba Susan Cornejo
Title
Coo
Phone
(850) 416-6206

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X FL
Rural Acute Care Hospital 282NR1301X FL Primary

Addresses

Primary practice location

3801 E Highway 98
Port St Joe, FL 32456-5318

Mailing address

7928 Solution Ctr
Lockbox 777928
Chicago, IL 60677-7009
Phone (850) 416-7190

Other identifiers 2

IdentifierTypeStateIssuer
159OtherFLBLUE CROSS OF FL
002012700MedicaidFL

Other names 1

  • Ascension Sacred Heart Gulf Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100127000189 FL Part A Provider - Hospital 9830231034 Practice locations: Port St Joe, FL
O20130619000194 FL Part A Provider - Hospital 9830231034 Practice locations: Port Saint Joe, FL; Wewahitchka, FL; Port St. Joe, FL; Mexico Beach, FL; Apalachicola, FL

Hospital certification: CCN 10U313

Legal name
ASCENSION SACRED HEART GULF
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 1963 in FL
Enrollment address
3801 East Highway 98
Port St Joe, FL 32456-5318
Hospital Swing-Bed Unit
Hospital subgroups
General, Acute care, Swing-bed approved

Hospital certification: CCN 100313

Legal name
ASCENSION SACRED HEART GULF
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Apr 12, 2010
Last certification
Jun 18, 2011
Beds
19
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 1963 in FL
Enrollment address
3801 E Highway 98
Port Saint Joe, FL 32456-5318
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension Sacred Heart GulfCCN 100313
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Sacred Heart Hospital10 organizations share this tax ID, including this one

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 7

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

NameRoleSinceShare
Coba Cornejo Individual Corporate OfficerCoo Nov 20, 2013
W-2 Managing Employee Nov 20, 2013
Operational/Managerial ControlCoo Nov 20, 2013
Corporate Officer Nov 20, 2013
Operational/Managerial Control Nov 20, 2013
Sacred Heart Health System Inc Organization, Pensacola, FL Non-profit 5% Or Greater Direct Ownership Interest Mar 15, 2010
Operational/Managerial Control Mar 15, 2010 100%
5% Or Greater Direct Ownership Interest Mar 15, 2010 100%
Carmon Bass Individual Corporate Director Jun 24, 2015
Jalima Trank Individual Corporate Officer Apr 3, 2023
W-2 Managing EmployeeCfo Apr 3, 2023
Operational/Managerial ControlCfo Apr 3, 2023
Corporate OfficerCfo Apr 3, 2023
Operational/Managerial Control Apr 3, 2023
Ascension Sacred Heart Gulf Organization, Port Saint Joe, FL Non-profit 5% Or Greater Direct Ownership Interest Mar 15, 2010
Kelly Beach Individual Corporate OfficerAdministrator Jul 1, 2022
W-2 Managing EmployeeAdministrator Jul 1, 2022
Operational/Managerial Control Jul 1, 2022
Don King Individual Corporate OfficerCeo Jul 1, 2022
W-2 Managing EmployeeCeo Jul 1, 2022
Operational/Managerial ControlCeo Jul 1, 2022

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 GulfApalachicola, FL, CCN 103452 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012
Ascension Medical Group Sacred Heart GulfWewahitchka, FL, CCN 108500 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.

Practitioners & affiliated clinicians

Affiliated clinicians 194

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 194

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1083941678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7928 SOLUTION CTR",
            "address_2": "LOCKBOX 777928",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606777009",
            "telephone_number": "850-416-7190",
            "fax_number": "850-416-7453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 E HIGHWAY 98",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324565318",
            "telephone_number": "850-229-5600",
            "fax_number": "850-416-7453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION SACRED HEART GULF",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "COBA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "850-416-6206"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF FL",
            "identifier": "159",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002012700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Sacred Heart Gulf",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Joe, FL

Sources for this page

Verify at the official NPI Registry.