Baptist Health Deaconess Medical Group Inc
Organization Active NPI Rural Health Clinic/Center · Hopkinsville, KY
NPI 1184205643 · NPPES record last updated Apr 21, 2021
Key facts
- NPI
- 1184205643
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BAPTIST HEALTH DEACONESS MEDICAL GROUP INC
- Practice address
- 500 Clinic Dr
Hopkinsville, KY 42240-4991 - Phone
- (270) 707-3329
- Fax
- (270) 707-3351
- NPI assigned
- Apr 16, 2021
- Organization subpart
- No
Authorized official
- Name
- Danyel D Clay
- Title
- Executive Director Revenue Cycle
- Phone
- (502) 253-4911
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 9
Change of ownership 1
Facilities with the same owner 11
Practitioners 252
-
Madeeha Ahmed, MD
-
John Reid Baker, MD
-
Peter E Carr, MD
-
Joshua Clapp, M.D.
-
James Diamond McNevin, MD & D.C.
-
Russell E Peyton, NP
-
Hatem Abed Asad, MD
-
Paul Edward Butts, M.D.
-
Asif Husain, MD
-
John Nicholas Vitali, D.O.
-
Bryce Gibson, MD
-
Maria A Palacios, MD
-
Chelsea Brown Adams, APRN, FNP-BC
-
Paul C Adjei, M.D.
-
Uqba Nawaz Ahmed, MD
-
Timi A Akins, MD
-
Muhammad Akram, MD
-
Leslie Nicole Allen, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 183856
- Legal name
- BAPTIST HEALTH DEACONESS MEDICAL GROUP INC
- Doing business as
- HOPKINSVILLE RHC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 7, 2019
- Last certification
- Oct 7, 2019
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 5, 2021 in KY
- Enrollment address
- 500 Clinic Dr
Hopkinsville, KY 42240-4991
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Baptist Health Deaconess, LLC |
5% Or Greater Direct Ownership Interest | Sep 1, 2021 | 100% |
| Marc J Florence |
Corporate Director |
Sep 1, 2021 | |
| Richard Carrico |
Corporate Director | Apr 12, 2023 | |
| Gerard Colman |
Corporate Director |
Sep 1, 2021 | |
| Lynn C Lingafelter |
Corporate Director |
Sep 1, 2021 | |
| Danyel D Clay |
Corporate Officer |
Sep 1, 2021 | |
| W-2 Managing Employee |
Sep 1, 2021 | ||
| Isaac J Myers |
Corporate Director |
Sep 1, 2021 | |
| Joseph W Prather |
Corporate Officer |
Sep 1, 2021 | |
| Valarie Howard |
Corporate Officer |
May 1, 2025 | |
| Shawn W McCoy |
Corporate Director |
Sep 1, 2021 | |
| James Porter |
Corporate Director |
Sep 1, 2021 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Sep 1, 2021 | Change of Ownership |
Hopkinsville Rural Health Center |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210810000993 | KY | Part B Supplier - Clinic/Group Practice | 6103220330 |
Receives reassigned benefits from 322 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Princeton, KY; Dawson Springs, KY; Powderly, KY; Madisonville, KY; Hopkinsville, KY; Clay, KY |
| O20211207001227 | KY | Part a Provider - Rural Health Clinic | 6103220330 | Practice locations: Hopkinsville, KY |
National Provider Directory
- Tax ID family
- Baptist Health Deaconess Medical Group Inc
Locations
500 Clinic Dr
#500
Hopkinsville, KY 42240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
500 Clinic Dr
Hopkinsville, KY 42240-4991
Mailing address
2701 Eastpoint Pkwy
Louisville, KY 40223-4166
Phone (502) 253-4911
Other names
- HOPKINSVILLE RHC
Other providers in Hopkinsville, KY
- Christie Lynn Baker
- Patricia Erin Baker
- Tatyana Baker
- Seon Hui Balistrere
- Chloe Balmer
- Baptist Health Madisonville Inc
- Baptist Health Medical Group Inc
- Baptist Medical Management Services Inc
- Barbara J.S. Newell MD PLLC
- Angela Barker
All providers in Hopkinsville, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.