Baker County Medical Services Inc
Organization Active NPI Rural Acute Care Hospital · Macclenny, FL
NPI 1104926401 · NPPES record last updated Jun 21, 2021
Key facts
- NPI
- 1104926401
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Acute Care Hospital 282NR1301X
- License
- 4152 (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
- Organization subpart
- No
Authorized official
- Name
- Mrs. Tiffany Varnadoe
- Title
- Chief Executive Officer
- Phone
- (904) 259-3151
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Related certifications (CCN) 1
Practitioners 57
-
Cameron Scott Cushenbery, CRNA
-
Sarah A Galloway, CRNA
-
Taylor Parker, APRN
-
Crystal Marie Satterwhite, FNP-C
-
Eric James Seybolt, CRNA
-
David F Taylor, CRNA
-
Russell Scott Avera, CRNA
-
Michael S Awai, CRNA
-
Latoya D Barnes, APRN
-
James Roy Biggerstaff, M.D.
-
Tiffany Faye Braddy, APRN
-
James G Chapman, MD
-
Paul M Crum Jr., MD
-
Efrain Deleon Jr., CRNA
-
Linda Louise Heilman, ARNP
-
Nicholas M Kalynych, CRNA
-
Jennie Knabb, CRNA
-
Magan Mona, NP-C
-
Jason A Moret, MD
-
Jonathan L Pabalate, CRNA
Affiliated clinicians 193
-
Muhammad I Akhtar, M.D.
-
Ernesto Alonso, MD
-
Kylie Jean Altman, APRN
-
Kelly Lynn Andrews, APRN
-
Hannan Asghar, M.D.
-
Majdi Ashchi, DO
-
Barbara Ann Austin, APRN
-
Lori Lynn Austin, APRN, FNP-C
-
Ravi Prasad Avati Nanjundappa, MD, MPH
-
Ayed O Ayed, M.D.
-
Adam Walker Bagley, M.D.
-
Angela Baker, ARNP
-
Eduardo Jose Balbona, M.D.
-
Bshara J Barakat, MD
-
Mirna F Barakat, MD
-
Ahmad Shah Barakzoy, M.D.
-
Robert Barrett, FNP-BC
-
Mary Blade, ARNP
Medicare Care Compare: Hospital
- Listed as
- Ed Fraser Memorial Hospital
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare Care Compare: Nursing home
- Listed as
- W Frank Wells Nursing Home
- 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
- Active
- Certified beds
- 69 · 58.2 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $26,320
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in FL
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
- Corporation · Non-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
- Corporation · Non-profit
- Incorporated
- Jul 26, 1993 in FL
- Enrollment address
- 159 North Third Street
Macclenny, FL 32063-2103 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Luanne Williams |
Corporate Officer |
Jan 4, 2011 | 14.29% |
| Sherrie Raulerson |
Corporate Officer |
Oct 1, 2005 | 14.29% |
| Corporate Director | Jan 29, 2009 | ||
| Corporate Director | Sep 13, 2007 | ||
| Dorinda Tillquist |
Corporate Officer |
May 20, 2022 | |
| Charles Kennedy |
Corporate Officer | Oct 1, 1993 | |
| Corporate Director | Jan 29, 2009 | ||
| Corporate Director |
Sep 13, 2007 | ||
| Tiffany Varnadoe |
Corporate Officer |
Jun 14, 2021 | |
| W-2 Managing Employee |
Jun 14, 2021 | ||
| Operational/Managerial Control |
Jun 14, 2021 | ||
| Corporate Director |
Jun 14, 2021 | ||
| Baker County Medical Services Inc |
Operational/Managerial Control | Oct 1, 1993 | 100% |
| Operational/Managerial Control | Sep 13, 2007 | ||
| Charles Wilson |
Corporate Officer |
Oct 1, 1993 | 14.29% |
| Corporate Director | Jan 29, 2009 | ||
| Corporate Director | Sep 13, 2007 | ||
| Charles Jackson |
Operational/Managerial Control |
Jan 21, 2023 | |
| Jeffrey Chilson |
Corporate Officer |
Jan 31, 2024 | |
| W-2 Managing Employee |
Jan 31, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Baker County Med SVCS Inc
Interoperability endpoints
- empaskey@bcms.medalliesdirect.net
- jyoung@bcms.medalliesdirect.net
- kathbennett@bcms.medalliesdirect.net
- jluciano@bcms.medalliesdirect.net
- tfparker@bcms.medalliesdirect.net
- spatel@bcms.medalliesdirect.net
- pwhite@bcms.medalliesdirect.net
- kknabb@bcms.medalliesdirect.net
- mhardin@bcms.medalliesdirect.net
- mhardin2@bcms.medalliesdirect.net
- pkanwar@bcms.medalliesdirect.net
- aabdelmagid@bcms.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Acute Care Hospital | 282NR1301X | 4152 | FL | Yes |
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010004800 | Medicaid | FL | |
| 266702900 | Medicaid | FL | |
| 021105200 | Medicaid | FL | |
| 022384100 | Medicaid | FL |
Other providers in Macclenny, FL
- Baker Community Health Center Inc
- Baker Community Medical Practice Inc
- Baker County Chiropractic Center
- Baker County Council on Aging, Inc
- Baker County Hospital Authority
- Baker County Medical Services Inc
- Baker County Medical Services Inc.
- Baker County Medical Services, Inc
- Baker County Medical Services, Inc
- Baker County School Board
All providers in Macclenny, FL · Rural Acute Care Hospital in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2021. 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.