NPIMap

Organization Active NPI

Baker County Medical Services Inc

  • Rural Acute Care Hospital
  • Macclenny, FL
National Provider Identifier
1104926401
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
4152 Issued in FL
Legal business name
BAKER COUNTY MEDICAL SERVICES INC
Practice address
159 N 3Rd St
Macclenny, FL 32063-2103
Phone
(904) 259-3151
Fax
(904) 259-3279
NPI assigned
Sep 25, 2006
Last updated
Jun 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Authorized official

Name
Mrs. Tiffany Varnadoe
Title
Chief Executive Officer
Phone
(904) 259-3151

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 4152 FL Primary
Skilled Nursing Facility 314000000X SNF1581096 FL
Community/Retail Pharmacy 3336C0003X PH13709 FL
Institutional Pharmacy 3336I0012X PH9039 FL
Institutional Pharmacy 3336I0012X PH13710 FL

Addresses

Primary practice location

159 N 3Rd St
Macclenny, FL 32063-2103

Mailing address

PO Box 484
Macclenny, FL 32063-0484
Phone (904) 259-3151

Other identifiers 4

IdentifierTypeStateIssuer
010004800MedicaidFL
266702900MedicaidFL
022384100MedicaidFL
021105200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040210000578 FL Part B Supplier - Clinic/Group Practice 6103710264 Receives reassigned benefits from 36 practitioners
Practice locations: Macclenny, FL
O20080528000534 FL Part A Provider - Skilled Nursing Facility 6103710264 Practice locations: Macclenny, FL
O20090306000179 FL Part A Provider - Hospital 6103710264 Practice locations: Macclenny, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1104926401. Details of each certification follow.

Skilled nursing facility certification: CCN 105210

Legal name
BAKER COUNTY MEDICAL SERVICES INC
Doing business as
W FRANK WELLS NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 20, 1969
Last certification
Dec 5, 2024
Beds
69
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Baker County medical Services, Inc.
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1993 in FL
Enrollment address
159 N 3Rd St
Macclenny, FL 32063-2103
Nursing home name
W FRANK WELLS NURSING HOME

Hospital certification: CCN 100134

Legal name
BAKER COUNTY MEDICAL SERVICES INC
Doing business as
ED FRASER MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 14, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1993 in FL
Enrollment address
159 North Third Street
Macclenny, FL 32063-2103
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ed Fraser Memorial HospitalCCN 100134 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Nursing home

Medicare Care Compare
Listed as
W Frank Wells Nursing HomeCCN 105210 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
5 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 20, 1969
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6958.2 residents per day on average
Penalties (3 years)
1Fines totaling $26,320

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Baker County Med SVCS Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

210 N 2nd St
Macclenny, FL 32063
Phone (904) 259-6168

Interoperability endpoints

  • Direct secure messaging: aabdelmagid@bcms.medalliesdirect.net
  • Direct secure messaging: empaskey@bcms.medalliesdirect.net
  • Direct secure messaging: jluciano@bcms.medalliesdirect.net
  • Direct secure messaging: jyoung@bcms.medalliesdirect.net
  • Direct secure messaging: kathbennett@bcms.medalliesdirect.net
  • Direct secure messaging: kknabb@bcms.medalliesdirect.net
  • Direct secure messaging: mhardin@bcms.medalliesdirect.net
  • Direct secure messaging: mhardin2@bcms.medalliesdirect.net
  • Direct secure messaging: pkanwar@bcms.medalliesdirect.net
  • Direct secure messaging: pwhite@bcms.medalliesdirect.net
  • Direct secure messaging: spatel@bcms.medalliesdirect.net
  • Direct secure messaging: tfparker@bcms.medalliesdirect.net

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Luanne Williams Individual Corporate OfficerBoard Member Jan 4, 2011 14.29%
Sherrie Raulerson Individual Corporate OfficerBoard Member Oct 1, 2005 14.29%
Corporate Director Jan 29, 2009
Corporate Director Sep 13, 2007
Dorinda Tillquist Individual Corporate OfficerDirector of Revenue Cycle Managemen May 20, 2022
Charles Kennedy Individual Corporate Officer Oct 1, 1993
Corporate Director Jan 29, 2009
Corporate DirectorBoard Member Sep 13, 2007
Tiffany Varnadoe Individual Corporate OfficerCeo Jun 14, 2021
W-2 Managing EmployeeCeo Jun 14, 2021
Operational/Managerial ControlCeo Jun 14, 2021
Corporate DirectorCeo Jun 14, 2021
Baker County Medical Services Inc Organization, Macclenny, FL Non-profit Operational/Managerial Control Oct 1, 1993 100%
Operational/Managerial Control Sep 13, 2007
Charles Wilson Individual Corporate OfficerBoard Member Oct 1, 1993 14.29%
Corporate Director Jan 29, 2009
Corporate Director Sep 13, 2007
Charles Jackson Individual Operational/Managerial ControlAdministrator Jan 21, 2023
Jeffrey Chilson Individual Corporate OfficerCfo Jan 31, 2024
W-2 Managing EmployeeCfo Jan 31, 2024

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

Affiliated clinicians 193

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

View all 193

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1104926401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 484",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320630484",
            "telephone_number": "904-259-3151",
            "fax_number": "904-259-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 N 3RD ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632103",
            "telephone_number": "904-259-3151",
            "fax_number": "904-259-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKER COUNTY MEDICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "VARNADOE",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "904-259-3151",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "FL",
            "license": "4152",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1581096",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH13709",
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "FL",
            "license": "PH9039",
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "FL",
            "license": "PH13710",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010004800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266702900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022384100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021105200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macclenny, FL

Sources for this page

Verify at the official NPI Registry.