NPIMap

Organization Active NPI

Southern Baptist Hospital of Florida Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1316112014
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
4448 Issued in FL
Legal business name
SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC
Practice address
800 Prudential Dr
Jacksonville, FL 32207-8202
Phone
(904) 202-2092
Fax
(904) 376-4280
NPI assigned
Apr 24, 2008
Organization subpart
Yes
Parent organization
SOUTHERN BAPTIST HOSPITAL OF FLORIDA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Philip Boyce
Title
Chief Revenue Officer
Phone
(904) 376-3760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 4448 FL Primary

Addresses

Primary practice location

800 Prudential Dr
Jacksonville, FL 32207-8202

Mailing address

PO Box 45094
Jacksonville, FL 32232-5094
Phone (904) 202-2092

Other identifiers 4

IdentifierTypeStateIssuer
010064102MedicaidFL
00103771AMedicaidGA
010064100MedicaidFL
120OtherFLBLUE CROSS OF FLORIDA

Other names 1

  • Baptist Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BaptistJAXHIM@direct.bmcjax.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120307000459 FL Part A Provider - Hospital 9032106190 Practice locations: Jacksonville, FL

Hospital certification: CCN 102330

Legal name
SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC
Doing business as
BAPTIST MEDICAL CENTER
Certification status
Active
Provider type (POS)
End-stage renal disease facility
Participating since
Mar 31, 1986
Last certification
Aug 28, 2025
Ownership / control type
Not for Profit
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1965 in FL
Enrollment address
800 Prudential Dr
Jacksonville, FL 32207-8202
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Baptist Medical Center - Pediatric DialysisCCN 102330
Ownership
Non-profit
Certified
Jun 15, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
5

National Provider Directory

National Provider Directory
Tax ID family
James Campbell18 organizations share this tax ID, including this one
Part of
James Campbell

Other organizations with this tax ID 17

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

View all 17

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
Nicole Thomas Individual Corporate OfficerPresident Dec 1, 2019
Edward Hubel Individual Corporate OfficerVice President Dec 1, 2021
Philip Boyce Individual Corporate OfficerV.P. & Chief Revenue Officer Jan 1, 2020
Joseph Mitrick Individual Corporate OfficerVice President Dec 1, 2019
Michael Aubin Individual Corporate OfficerVice President Mar 14, 2011
Thomas Finnegan Individual Corporate Officer Dec 1, 2019
Michael Mayo Individual Corporate OfficerCeo and Hospital President Jul 5, 2011
Matthew Zuino Individual Corporate OfficerExec VP and Chief Operating Officer Jul 16, 2021
Nicole Blackwelder Individual Corporate DirectorDirector Dec 1, 2019
Scott Baity Individual Corporate OfficerLegal President Dec 1, 2019
Paige Hayes Individual W-2 Managing EmployeeDirector of Medical Records Dec 1, 2019

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1316112014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45094",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322325094",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078202",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC",
        "enumeration_date": "2008-04-24",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "BOYCE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "CHIEF REVENUE OFFICER",
        "authorized_official_telephone_number": "904-376-3760"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "FL",
            "license": "4448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064102",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00103771A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF FLORIDA",
            "identifier": "120",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BaptistJAXHIM@direct.bmcjax.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "800 Prudential Dr",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322078202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Baptist Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baptist Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.