Baptist Health Deaconess Medical Group Inc
Organization Active NPI Rural Health Clinic/Center · Madisonville, KY
NPI 1306420575 · NPPES record last updated Dec 18, 2023
Key facts
- NPI
- 1306420575
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Kim Ashby
- Title
- VPF
- Phone
- (270) 825-5781
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 9
Facilities with the same owner 11
Practitioners 244
-
Heather Christian Clouse, P.A.
-
Denise H Sparks, APRN
-
David A Craig, MD
-
Chelsea Brown Adams, APRN, FNP-BC
-
Paul C Adjei, M.D.
-
Madeeha Ahmed, MD
-
Uqba Nawaz Ahmed, MD
-
Timi A Akins, MD
-
Muhammad Akram, MD
-
Leslie Nicole Allen, APRN
-
Humza A Ansari, MD
-
Julie Ann Bak, AU.D
-
John Reid Baker, MD
-
Brandi Susanne Baldwin, AGACNP
-
Eric L Bandy, MD
-
Andrew Banks, MD
-
Vishal Bansal, MD
-
Duska Suede Dixie Bethel, DNP, AGACNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
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
- Corporation · Non-profit
- Incorporated
- Apr 5, 2021 in KY
- Enrollment address
- 200 Clinic Dr
Suite 1, 4TH & 5TH Floor
Madisonville, KY 42431-1661
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Baptist Health Deaconess, LLC |
5% Or Greater Direct Ownership Interest | Dec 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 |
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 |
| O20220124000839 | KY | Part a Provider - Rural Health Clinic | 6103220330 | Practice locations: Madisonville, KY |
National Provider Directory
- Tax ID family
- Baptist Health Deaconess Medical Group Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- BHDMG Family Medicine and Endocrinology
Other providers in Madisonville, KY
- Baptist Health Deaconess Madisonville Inc
- Baptist Health Deaconess Madisonville Inc
- Baptist Health Deaconess Madisonville Inc
- Baptist Health Deaconess Madisonville Inc
- Baptist Health Deaconess Medical Group Inc
- Baptist Health Deaconess Medical Group Inc
- Baptist Health Deaconess Medical Group Inc
- Baptist Health Deaconess Medical Group Inc
- Baptist Health Deaconess Medical Group Inc
- Baptist Health Deaconess Medical Group Inc
All providers in Madisonville, 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 Dec 18, 2023. 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.