NPIMap

Organization Active NPI

Holmes County Hospital Corp

Doing business as Doctors Memorial Hospital

  • Critical Access Hospital
  • Bonifay, FL
National Provider Identifier
1366431702
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
4427 Issued in FL
Legal business name
HOLMES COUNTY HOSPITAL CORP
Doing business as
Doctors Memorial Hospital
Practice address
2600 Hospital Drive
Bonifay, FL 32425
Phone
(850) 547-8015
Fax
(850) 547-8025
NPI assigned
Oct 18, 2005
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mrs. Joann Baker
Title
Administrator/Ceo
Phone
(850) 547-8001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 4427 FL Primary
Critical Access Hospital 282NC0060X

Addresses

Primary practice location

2600 Hospital Drive
Bonifay, FL 32425

Mailing address

P.O. Box 188
Bonifay, FL 32425
Phone (850) 547-8015

Other names 1

  • Doctors Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20060203000151 FL Part A Provider - Hospital 3375557887 Practice locations: Bonifay, FL
O20101122001377 FL Part B Supplier - Clinic/Group Practice 3375557887 Receives reassigned benefits from 56 practitioners
2 other NPIs on this enrollment
Practice locations: Bonifay, FL
O20120221000281 FL Part A Provider - Critical Access Hospital 3375557887 Receives reassigned benefits from 2 practitioners
Practice locations: Bonifay, FL

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1366431702. Details of each certification follow.

Hospital certification: CCN 101307

Legal name
HOLMES COUNTY HOSPITAL CORP
Doing business as
DOCTORS MEMORIAL HOSPITAL - BONIFAY
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2002
Last certification
Jun 13, 2002
Beds
20
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1955 in FL
Enrollment address
2600 Hospital Dr
Bonifay, FL 32425-4264
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Hospital certification: CCN 10Z307

Legal name
HOLMES COUNTY HOSPITAL CORP
Doing business as
DOCTORS MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
in FL
Enrollment address
2600 Hospital Drive
Doctors Memorial Hospital
Bonifay, FL 32425-0188
Other Hospital Practice Location

Hospital certification: CCN 100078

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DOCTORS MEMORIAL HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Jul 1, 2002
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 15, 1999
Beds
25
Ownership / control type
Local
Facility address
2600 Hospital Dr
Bonifay, FL 32425

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Doctors Memorial HospitalCCN 101307 · All quality measures
Overall star rating
2 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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
10D0270672Doctors Memorial Hospital2600 Hospital Dr, Bonifay, FL 32425AccreditationJan 2, 2027

National Provider Directory

National Provider Directory

Locations

2910 Hospital Dr
Ste A
Bonifay, FL 32425
Phone (850) 547-8118

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Heather Nelson Individual Other Jul 1, 2021
Ronald C Jamison Individual Corporate OfficerChief Financial Officer Sep 16, 2020
Donna Boroughs Individual OtherBusiness Office Director Apr 1, 2008
W-2 Managing EmployeeBusiness Office Manager Jul 1, 2002
Cynthia Brooks Individual Corporate DirectorChairman of the Board Dec 20, 2019 5%
Rohan Anderson Individual Operational/Managerial ControlCeo Jan 28, 2025
Jennie Goodman Individual OtherBoard Member Aug 27, 2020
Joann Baker Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2010
W-2 Managing EmployeeAdministrator/Ceo Feb 1, 2010 100%
Corporate OfficerCeo/Administrator Jul 1, 2002 100%
W-2 Managing EmployeeCeo/Administrator Jul 1, 2002 100%
Operational/Managerial ControlCeo/Administrator Jul 1, 2002 100%
Jerry Dixon Individual OtherBoard Member Aug 27, 2020

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bonifay Rural Health ClinicBonifay, FL, CCN 103462 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 58

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 58

Affiliated clinicians 86

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

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1366431702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 188",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "32425",
            "telephone_number": "850-547-8015",
            "fax_number": "850-547-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 HOSPITAL DRIVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "32425",
            "telephone_number": "850-547-8015",
            "fax_number": "850-547-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLMES COUNTY HOSPITAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "850-547-8001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "FL",
            "license": "4427",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Doctors Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonifay, FL

Sources for this page

Verify at the official NPI Registry.