NPIMap

Organization Active NPI

Baptist Health Deaconess Medical Group Inc

  • Rural Health Clinic/Center
  • Madisonville, KY
National Provider Identifier
1306420575
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST HEALTH DEACONESS MEDICAL GROUP INC
Practice address
200 Clinic Dr FL 5
Madisonville, KY 42431-1661
Phone
(270) 825-7214
NPI assigned
May 12, 2021
Last updated
Dec 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Kim Ashby
Title
VPF
Phone
(270) 825-5781

Specialties & licenses 1

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

Addresses

Primary practice location

200 Clinic Dr FL 5
Madisonville, KY 42431-1661

Mailing address

5200 Commerce Crossings Dr FL 3
Louisville, KY 40229-2182
Phone (502) 253-4911

Other names 1

  • BHDMG Family Medicine and Endocrinology Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20220124000839 KY Part A Provider - Rural Health Clinic 6103220330 Practice locations: Madisonville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306420575. Details of each certification follow.

Rural health clinic certification: CCN B03916

Legal name
BAPTIST HEALTH DEACONESS MEDICAL GROUP INC
Doing business as
MADISONVILLE FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 12, 2023
Last certification
May 12, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 2021 in KY
Enrollment address
200 Clinic Dr
Suite 1, 4TH & 5TH Floor
Madisonville, KY 42431-1661

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Baptist Health Deaconess Medical Group Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

4011 Gateway Blvd
#16094
Newburgh, IN 47630

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Baptist Health Deaconess, LLC Organization, Louisville, KY LLC, Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2021 100%
Marc J Florence Individual Corporate DirectorBoard Member Sep 1, 2021
Richard Carrico Individual Corporate DirectorDirector Apr 12, 2023
Gerard Colman Individual Corporate DirectorBoard Member Sep 1, 2021
Lynn C Lingafelter Individual Corporate DirectorBoard Member Sep 1, 2021
Danyel D Clay Individual Corporate OfficerVice President Sep 1, 2021
W-2 Managing EmployeeVice President Sep 1, 2021
Isaac J Myers Individual Corporate DirectorBoard Member Sep 1, 2021
Joseph W Prather Individual Corporate OfficerChief Strategy & Marketing Officer Sep 1, 2021
Valarie Howard Individual Corporate OfficerCfo May 1, 2025
Shawn W McCoy Individual Corporate DirectorBoard Member Sep 1, 2021
James Porter Individual Corporate DirectorBoard Member Sep 1, 2021

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1306420575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 COMMERCE CROSSINGS DR FL 3",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402292182",
            "telephone_number": "502-253-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CLINIC DR FL 5",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311661",
            "telephone_number": "270-825-7214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH DEACONESS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "ASHBY",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "VPF",
        "authorized_official_telephone_number": "270-825-5781"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHDMG Family Medicine and Endocrinology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madisonville, KY

Sources for this page

Verify at the official NPI Registry.