NPIMap

Organization Active NPI

St Lukes - St Vincents Healthcare

Doing business as Ascension St. Vincent's Southside

  • General Acute Care Hospital
  • Jacksonville, FL
National Provider Identifier
1396926747
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
ST LUKES - ST VINCENTS HEALTHCARE
Doing business as
Ascension St. Vincent's Southside
Practice address
4201 Belfort Rd
Jacksonville, FL 32216-1431
Phone
(904) 296-3700
NPI assigned
Nov 14, 2007
Last updated
Apr 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Jeremy Dean Kraft
Title
Director- Net Revenue
Phone
(904) 450-6020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

4201 Belfort Rd
Jacksonville, FL 32216-1431

Mailing address

4205 Belfort Rd
Jab # 4020
Jacksonville, FL 32216
Phone (904) 450-6020

Other names 1

  • Ascension St. Vincent's Southside Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080110000704 FL Part A Provider - Hospital 2668553058

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396926747. Details of each certification follow.

Hospital certification: CCN 100307

Legal name
ST LUKES - ST VINCENTS HEALTHCARE
Doing business as
ASCENSION ST. VINCENT'S SOUTHSIDE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
May 6, 2008
Last certification
Jan 9, 2013
Beds
295
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 26, 2007 in FL
Enrollment address
4201 Belfort Rd
Jacksonville, FL 32216-1431
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St Vincent's SouthsideCCN 100307 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
St Lukes-St Vincents Healthcare5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

12525 Beach Blvd
Jacksonville, FL 32246
Phone (904) 296-4300

4201 Belfort Rd
Ste 103
Jacksonville, FL 32216

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Jeremy Kraft Individual Corporate DirectorDirector-Net Revenue Aug 10, 2016
W-2 Managing EmployeeDirector- Net Revenue Aug 10, 2016
Helen Rowan Individual Corporate Director Jul 1, 2015
St Lukes - St Vincents Healthcare Organization, Jacksonville, FL Non-profit 5% Or Greater Direct Ownership Interest Apr 12, 2008 100%
Coba Cornejo Individual Corporate OfficerChief Operating Officer Jun 1, 2018
W-2 Managing EmployeeChief Operating Officer Jun 1, 2018
Operational/Managerial ControlChief Operating Officer Jun 1, 2018
Don King Individual Corporate OfficerSenior Vice President May 1, 2023
W-2 Managing EmployeeSenior Vice President May 1, 2023
Operational/Managerial ControlSenior Vice President May 1, 2023
Patrick George Individual Corporate OfficerChief Financial Officer Jun 1, 2026
W-2 Managing EmployeeChief Financial Officer Jun 1, 2026
Operational/Managerial ControlChief Financial Officer Jun 1, 2026
Kevin Rinks Individual Corporate OfficerPresident Jul 1, 2024
W-2 Managing EmployeePresident Jul 1, 2024
Operational/Managerial ControlPresident Jul 1, 2024
St. Vincent's Health System, Inc. Organization, Jacksonville, FL Non-profit 5% Or Greater Indirect Ownership Interest Apr 12, 2008 100%
US Bank National Association Organization, Philadelphia, PA Created for acquisition, Financial institution 5% Or Greater Security Interest May 22, 2013 100%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Ascension St. Vincent's SouthsideJacksonville, FL, CCN 10T307 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 12, 2008

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 558

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

View all 558

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1396926747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD",
            "address_2": "JAB # 4020",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32216",
            "telephone_number": "904-450-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 BELFORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161431",
            "telephone_number": "904-296-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES - ST VINCENTS HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "KRAFT",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "DIRECTOR- NET REVENUE",
        "authorized_official_telephone_number": "904-450-6020"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent's Southside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.