NPIMap

Organization Active NPI

Baker County Medical Services Inc

Doing business as Baker Rural Health Clinic

  • Rural Health Clinic/Center
  • Macclenny, FL
National Provider Identifier
1386082220
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAKER COUNTY MEDICAL SERVICES INC
Doing business as
Baker Rural Health Clinic
Practice address
159 N 3Rd St
Macclenny, FL 32063-2103
Phone
(904) 259-3151
Fax
(904) 259-3279
NPI assigned
Jun 13, 2013
Last updated
Jun 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BAKER COUNTY MEDICAL SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Authorized official

Name
Mr. Tiffany Varnadoe
Title
Ceo
Phone
(904) 259-3151

Specialties & licenses 1

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

Addresses

Primary practice location

159 N 3Rd St
Macclenny, FL 32063-2103

Mailing address

159 N 3Rd St
Macclenny, FL 32063-2103
Phone (904) 259-3151

Other names 1

  • BAKER RURAL HEALTH CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131024001674 FL Part A Provider - Rural Health Clinic 6103710264 Practice locations: Macclenny, FL
O20250828002948 FL Part B Supplier - Independent Clinical Laboratory 6103710264 Practice locations: Macclenny, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386082220. Details of each certification follow.

Rural health clinic certification: CCN 103453

Legal name
BAKER COUNTY MEDICAL SERVICES INC
Doing business as
BAKER RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 11, 2014
Last certification
Aug 15, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1993 in FL
Enrollment address
155 N 3Rd St
Macclenny, FL 32063-2103
Related CCNs
100134

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

Other NPIs with the same Medicare PAC ID 2

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

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
10D2064833Baker Rural Health Clinic159 N 3Rd St, Macclenny, FL 32063Certificate of waiverAug 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baker County Med SVCS Inc5 organizations share this tax ID, including this one
Part of
Baker County Med SVCS Inc

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Luanne Williams Individual Corporate OfficerBoard Member Jan 4, 2011 16.67%
Sherrie Raulerson Individual Corporate OfficerBoard Member Oct 1, 2005 16.67%
Dorinda Tillquist Individual Corporate OfficerDirector of Revenue Cycle Managemen May 4, 2022
Charles Kennedy Individual Corporate OfficerChairman of Board Members Oct 1, 1993 16.67%
Tiffany Varnadoe Individual Corporate OfficerChief Executive Officer May 4, 2022
Corporate DirectorChief Executive Officer May 4, 2022
W-2 Managing EmployeeChief Executive Officer May 4, 2022
Operational/Managerial ControlChief Executive Officer May 4, 2022
Phillip Rhoden Individual Corporate OfficerBoard Member Apr 7, 2022 16.66%
Charles Wilson Individual Corporate OfficerBoard Member Oct 1, 1993 16.66%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Ed Fraser Memorial HospitalMacclenny, FL, CCN 100134 Hospital Operational/Managerial Control (100%) Oct 1, 1993
W Frank Wells Nursing HomeMacclenny, FL, CCN 105210 Skilled nursing facility Operational/Managerial Control Sep 13, 2007

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 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1386082220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 N 3RD ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632103",
            "telephone_number": "904-259-3151",
            "fax_number": "904-259-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 N 3RD ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320632103",
            "telephone_number": "904-259-3151",
            "fax_number": "904-259-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKER COUNTY MEDICAL SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAKER COUNTY MEDICAL SERVICES INC",
        "enumeration_date": "2013-06-13",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "VARNADOE",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-259-3151",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAKER RURAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BAKER RURAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macclenny, FL

Sources for this page

Verify at the official NPI Registry.