NPIMap

Organization Active NPI

Flagler Hospital, Inc.

  • Urgent Care Clinic/Center
  • St Augustine, FL
National Provider Identifier
1447527965
Registry record updated Nov 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
5665 Issued in FL
Legal business name
FLAGLER HOSPITAL, INC.
Practice address
400 Health Park Blvd
Saint Augustine, FL 32086-5784
Phone
(904) 819-5155
Fax
(904) 819-4906
NPI assigned
Nov 29, 2011
Last updated
Nov 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2011

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

Authorized official

Name
Mr. Joseph S Gordy
Title
Ceo/President
Phone
(904) 819-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 5665 FL Primary

Addresses

Primary practice location

400 Health Park Blvd
Saint Augustine, FL 32086-5784

Mailing address

400 Health Park Blvd
Saint Augustine, FL 32086-5784
Phone (904) 819-5155

Other identifiers 1

IdentifierTypeStateIssuer
010171100MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100730000646 FL Part A Provider - Hospital 7911964994 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Augustine, FL; St Augustine, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447527965. Details of each certification follow.

Hospital certification: CCN 100090

Legal name
FLAGLER HOSPITAL INC
Doing business as
UF HEALTH FLAGLER HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 15, 2006
Beds
335
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1905 in FL
Enrollment address
400 Health Park Blvd
St Augustine, FL 32086-5784
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Flagler HospitalCCN 100090 · All quality measures
Overall star rating
3 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

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
James Kelly Individual Corporate DirectorBoard Member Sep 1, 2023
George Bailey Individual Corporate OfficerCfo Sep 1, 2023
W-2 Managing EmployeeCfo Sep 1, 2023
David R Nelson Individual Corporate DirectorBoard Member Sep 1, 2023
Susan Ponder Stansel Individual Corporate DirectorBoard Member Sep 1, 2023
Shands Teaching Hospital and Clinics Inc Organization, Gainesville, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2023 100%
Chris Kamienski Individual Corporate DirectorBoard Member Sep 1, 2023
Timothy E Morey Individual Corporate DirectorBoard Member Sep 1, 2023
Cindy Charyulu-D'Orra Individual Contracted Managing Employee Jun 4, 2024
W-2 Managing EmployeeVice President Revenue Cycle Jun 4, 2024 100%
Flagler Hospital Inc Organization, Saint Augustine, FL Corporation Operational/Managerial Control Jan 1, 1966 100%

Owners & managing parties with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 659

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

View all 659

NPI Registry JSON

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

{
    "created_epoch": "1322524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322524800000",
    "number": "1447527965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HEALTH PARK BLVD",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865784",
            "telephone_number": "904-819-5155",
            "fax_number": "904-819-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HEALTH PARK BLVD",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865784",
            "telephone_number": "904-819-5155",
            "fax_number": "904-819-4906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-29",
        "last_updated": "2011-11-29",
        "status": "A",
        "authorized_official_last_name": "GORDY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "904-819-4400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "FL",
            "license": "5665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010171100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.