NPIMap

Organization Active NPI

Baptist Health Medical Group Inc

Doing business as Rural Health Clinic Barbourville

  • Rural Health Clinic/Center
  • Barbourville, KY
National Provider Identifier
1184119398
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST HEALTH MEDICAL GROUP INC
Doing business as
Rural Health Clinic Barbourville
Practice address
602 Knox St
Barbourville, KY 40906-1304
Phone
(606) 546-6027
Fax
(606) 546-2084
NPI assigned
Jun 29, 2018
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Authorized official

Name
Matthew Lazari
Title
Vice President
Phone
(502) 489-8668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

602 Knox St
Barbourville, KY 40906-1304

Mailing address

1901 Campus PL
Louisville, KY 40299-2308
Phone (502) 253-4911

Other identifiers 2

IdentifierTypeStateIssuer
18-8935OtherKYMEDICARE
7100315380MedicaidKY

Other names 1

  • Rural Health Clinic Barbourville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070228000503 KY Part B Supplier - Clinic/Group Practice 5597867184 Receives reassigned benefits from 1,548 practitioners
40 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20150603002897 KY Part A Provider - Rural Health Clinic 5597867184 1 other NPI on this enrollment
Practice locations: Barbourville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184119398. Details of each certification follow.

Rural health clinic certification: CCN 188935

Legal name
BAPTIST HEALTH MEDICAL GROUP INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 2, 2014
Last certification
Mar 28, 2014
Ownership / control type
1B
Most recent change of ownership
Jan 1, 2015 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2015 in KY
Enrollment address
602 Knox St
Barbourville, KY 40906-1304

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Staci Dawn Farner Rogers Individual Corporate DirectorBoard Member Jan 1, 2022
Richard Carrico Individual Corporate OfficerVice President Apr 12, 2023
Christion Hutson Individual Corporate DirectorBoard Member Jan 1, 2026
Janet Norton Individual Corporate OfficerSecretary Sep 1, 2014
Frank Purdy Individual Corporate DirectorBoard Member Jan 1, 2022
Victoria Buster Individual Corporate DirectorBoard Member Jan 1, 2023
Danyel D Clay Individual Corporate OfficerVice President Jan 1, 2023
W-2 Managing EmployeeVice President Jan 1, 2023
Isaac J Myers Individual Corporate OfficerPresident Jan 10, 2018
Susan S Tamme Individual Corporate DirectorBoard Member Jan 1, 2026
Joanne M Berryman Individual Corporate DirectorBoard Member Jan 1, 2024
Baptist Healthcare System Inc Organization, Louisville, KY Corporation, Non-profit Operational/Managerial Control Jan 1, 2015
Ronald Douglas Reed Individual Corporate OfficerVice President Jan 17, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 29

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 29

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1184119398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CAMPUS PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402992308",
            "telephone_number": "502-253-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 KNOX ST",
            "city": "BARBOURVILLE",
            "state": "KY",
            "postal_code": "409061304",
            "telephone_number": "606-546-6027",
            "fax_number": "606-546-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-29",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "LAZARI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "502-489-8668"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "18-8935",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100315380",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Clinic Barbourville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barbourville, KY

Sources for this page

Verify at the official NPI Registry.