NPIMap

Organization Active NPI

Baycare Behavioral Health Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • St Petersburg, FL
National Provider Identifier
1114295680
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BAYCARE BEHAVIORAL HEALTH INC.
Practice address
560 Jackson St N Ste 302
St Petersburg, FL 33705-1449
Phone
(727) 820-7701
NPI assigned
Dec 12, 2011
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Mrs. Lynda Gorken
Title
Vice President
Phone
(727) 281-9390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

560 Jackson St N Ste 302
St Petersburg, FL 33705-1449

Mailing address

2995 Drew St FL 2
Clearwater, FL 33759-3012
Phone (727) 281-9390

Other identifiers 1

IdentifierTypeStateIssuer
060297319MedicaidFL

Other names 1

  • St. Pete - Primary Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040830000131 FL Part B Supplier - Clinic/Group Practice 4688649122 Receives reassigned benefits from 218 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Port Richey, FL; Trinity, FL; Tampa, FL; St Petersburg, FL; Saint Petersburg, FL; Largo, FL; Dade City, FL; Brooksville, FL

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

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
10D2275041Baycare Behavioral Health, Inc560 Jackson St N - Ste 302, Saint Petersburg, FL 33705Certificate of waiverJan 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
The Harbor B H C I28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

15311 Cortez Blvd
Brooksville, FL 34613
Phone (352) 467-6529

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1114295680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 DREW ST FL 2",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337593012",
            "telephone_number": "727-281-9390",
            "fax_number": "813-635-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 JACKSON ST N STE 302",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051449",
            "telephone_number": "727-820-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYCARE BEHAVIORAL HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "GORKEN",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "727-281-9390",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060297319",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Pete - Primary Care",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St. Pete - Primary Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.