NPIMap

Organization Active NPI

Baycare Alliant Hospital Inc

  • Long Term Care Hospital
  • Dunedin, FL
National Provider Identifier
1174716955
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
BAYCARE ALLIANT HOSPITAL INC
Practice address
601 Main St
Mailstop 402
Dunedin, FL 34698-5848
Phone
(727) 734-6302
Fax
(727) 734-6486
NPI assigned
Aug 24, 2007
Last updated
Nov 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Authorized official

Name
Ms. Anita Russell, M.P.H
Title
Executive Director
Phone
(727) 734-6302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X Primary

Addresses

Primary practice location

601 Main St
Mailstop 402
Dunedin, FL 34698-5848

Mailing address

601 Main St
Mailstop 402
Dunedin, FL 34698-5848
Phone (727) 281-9479

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080703000237 FL Part A Provider - Hospital 5991877193 Practice locations: Dunedin, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1174716955. Details of each certification follow.

Hospital certification: CCN 102021

Legal name
BAYCARE ALLIANT HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Mar 6, 2008
Last certification
Jan 29, 2020
Beds
48
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 9, 2004 in FL
Enrollment address
601 Main St
Ms 402
Dunedin, FL 34698-5848
Other Hospital Practice Location
Hospital subgroups
Long-term

Hospital certification: CCN 100308

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BAYCARE ALLIANT HOSPITAL
Certification status
Terminated Other: provider status change, Oct 31, 2008
Provider type (POS)
Hospital – Short-term
Participating since
Apr 29, 2008
Last certification
Apr 29, 2008
Beds
48
Ownership / control type
Private (not for profit)
Facility address
601 Main St
Dunedin, FL 34698

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Baycare Alliant HospitalCCN 102021 · All quality measures
Ownership
Non-profit
Certified
Mar 6, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Beds
48

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
10D1078465Baycare Alliant Hospital601 Main Street - Mail Stop 402, Dunedin, FL 34698Certificate of waiverJan 9, 2028

National Provider Directory

National Provider Directory

Locations

601 Main St
#402
Dunedin, FL 34698
Phone (727) 734-6302

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jon M Brethauer Individual Corporate Director Feb 21, 2024
Su Reynard-Suriano Individual Corporate DirectorBoard Member Feb 21, 2018
Ronald Beamon Individual Corporate DirectorBoard Member Sep 26, 2018
Harold Holderith Individual Corporate DirectorBoard Member Jan 2, 2008
Maya Perez Individual Corporate OfficerPresident Dec 1, 2023
Operational/Managerial Control Dec 1, 2023
Brandon May Individual Corporate Director May 1, 2024
Charles Robinson Individual Corporate DirectorBoard Member Jan 1, 2013
Dana M Garstecki Individual Operational/Managerial Control May 2, 2022

Practitioners & affiliated clinicians

Affiliated clinicians 11

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

NPI Registry JSON

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574294400000",
    "number": "1174716955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MAIN ST",
            "address_2": "MAILSTOP 402",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346985848",
            "telephone_number": "727-281-9479",
            "fax_number": "727-734-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 MAIN ST",
            "address_2": "MAILSTOP 402",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346985848",
            "telephone_number": "727-734-6302",
            "fax_number": "727-734-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYCARE ALLIANT HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2019-11-21",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "727-734-6302",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.P.H"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunedin, FL

Sources for this page

Verify at the official NPI Registry.