NPIMap

Organization Active NPI

Baptist Health Medical Group Inc

  • Rural Health Clinic/Center
  • Bardstown, KY
National Provider Identifier
1194320630
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
Practice address
3615 E John Rowan Blvd Ste 104
Bardstown, KY 40004-3264
Phone
(502) 348-5968
Fax
(270) 706-5802
NPI assigned
Dec 2, 2020
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

3615 E John Rowan Blvd Ste 104
Bardstown, KY 40004-3264

Mailing address

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

Other names 1

  • Bardstown Family Medicine Other name

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
O20211117000768 KY Part A Provider - Rural Health Clinic 5597867184 Practice locations: Bardstown, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194320630. Details of each certification follow.

Rural health clinic certification: CCN B03909

Legal name
BAPTIST HEALTH MEDICAL GROUP INC
Doing business as
BARDSTOWN FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 19, 2023
Last certification
Jan 19, 2023
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 2006 in KY
Enrollment address
3615 E John Rowan Blvd
Ste 104
Bardstown, KY 40004-3264

Other NPIs on the same Medicare enrollment 40

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

View all 40

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
18D0320357Baptist Health Medical Group Family Medicine3615 East John Rowan Blvd Suite 104, Bardstown, KY 40004Certificate of waiverJun 4, 2028
18D2018431Baptist Health Medical Group General3615 East John Rowan Blvd Suite 203, Bardstown, KY 40004Provider-performed microscopyJan 4, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the 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 Director Jan 1, 2022
Richard Carrico Individual Corporate Officer Apr 12, 2023
Christion Hutson Individual Corporate DirectorBoard Member Jan 1, 2026
Janet Norton Individual Corporate OfficerVice President Jul 21, 2006
Frank Purdy Individual Corporate Director Jan 1, 2022
Victoria Buster Individual Corporate Director Jan 1, 2023
Danyel D Clay Individual Corporate OfficerVice President Sep 1, 2021
W-2 Managing EmployeeVice President Sep 1, 2021
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 5% Or Greater Direct Ownership Interest Sep 1, 2020 100%
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 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1606867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1194320630",
    "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": "3615 E JOHN ROWAN BLVD STE 104",
            "city": "BARDSTOWN",
            "state": "KY",
            "postal_code": "400043264",
            "telephone_number": "502-348-5968",
            "fax_number": "270-706-5802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-02",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bardstown Family Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bardstown Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bardstown, KY

Sources for this page

Verify at the official NPI Registry.