NPIMap

Organization Active NPI

Southern Baptist Hospital of Florida Inc

  • Psychiatric Hospital
  • Jacksonville, FL
National Provider Identifier
1457526154
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
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) 202-2000
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
Psychiatric Hospital 283Q00000X 4448 FL Primary

Addresses

Primary practice location

800 Prudential Dr
Jacksonville, FL 32207-8202

Mailing address

800 Prudential Dr
Jacksonville, FL 32207-8202
Phone (904) 202-2000

Other identifiers 3

IdentifierTypeStateIssuer
010064100MedicaidFL
010064102MedicaidFL
120OtherFLBLUE CROSS OF FL

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
O20071222000051 FL Part A Provider - Hospital 9032106190 1 other NPI on this enrollment
Practice locations: Jacksonville, FL

Hospital certification: CCN 10S088

Legal name
SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC
Doing business as
BAPTIST MEDICAL CENTER
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
Psychiatric unit

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).

Other NPIs on the same Medicare enrollment 1

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

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 13

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

NameRoleSinceShare
Kyle T Reese Individual Corporate DirectorBoard Member May 13, 2013
Philip Boyce Individual Corporate OfficerSVP & Chief Revenue Officer Jan 1, 2020
Richard L Sisisky Individual Corporate DirectorBoard Member Nov 1, 2004
Charles E Hughes Individual Corporate DirectorBoard Member May 28, 1985
Robert E Hill Individual Corporate DirectorBoard Member Jun 1, 2006
Baptist Health System Inc Organization, Jacksonville, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 29, 1983 100%
Richard D Glock Individual Corporate DirectorBoard Member Nov 1, 2004
Thomas Finnegan Individual Corporate OfficerSVP & Finance & Treasury Officer Dec 1, 2019
W-2 Managing Employee Dec 1, 2019
Barbara G Jaffe Individual Corporate DirectorBoard Member Mar 1, 2010
Eric Mann Individual Corporate DirectorBoard Member Mar 3, 2012
Pamela Chally Individual Corporate DirectorBoard Member Mar 3, 2012
Ava Parker Individual Corporate DirectorBoard Member Nov 1, 2010
Charles C Baggs Individual Corporate DirectorBoard Member Jun 1, 2006

Owners & managing parties with NPI records 1

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

Facilities with the same owner 3

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

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": "1457526154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078202",
            "telephone_number": "904-202-2000",
            "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": "904-202-2000",
            "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": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "FL",
            "license": "4448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064102",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF FL",
            "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.