Baptist Health Medical Group Inc
Organization Active NPI Rural Health Clinic/Center · Benton, KY
NPI 1487210654 · NPPES record last updated Jul 22, 2024
Key facts
- NPI
- 1487210654
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BAPTIST HEALTH MEDICAL GROUP INC
- Practice address
- 543 Powell LN
Benton, KY 42025-5366 - Phone
- (270) 415-7070
- Fax
- (270) 415-4071
- NPI assigned
- May 14, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- BAPTIST HEALTH MEDICAL GROUP INC
Authorized official
- Name
- Mrs. Danyel D Clay
- Title
- VP Revenue Cycle
- Phone
- (502) 253-4911
Owners & managing parties with NPI records 1
-
Staci Dawn Rogers, M.D.
Other NPIs on the same Medicare enrollment 40
Member of 1
Facilities with the same owner 29
Practitioners 12
-
Richard H Byers Jr., ARNP
-
Lynnelle Cain, NP
-
Ali Janell Jessee, D.O.
-
Shauna Kristen Johnson, APRN
-
Josh Mikel Pugh, PA-C
-
Cody A Sexton, APRN
-
Joshua D Stevens, M.D.
-
Jennifer L Vertrees, APRN
-
Patricia H Woodruff, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2167806 | Baptist Health Medical Group Primary Care | Certificate of waiver | Jun 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN B03806
- Legal name
- BAPTIST HEALTH MEDICAL GROUP INC
- Doing business as
- BENTON RURAL HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 25, 2019
- Last certification
- Oct 14, 2019
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 21, 2006 in KY
- Enrollment address
- 543 Powell LN
Benton, KY 42025-5366
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Staci Dawn Farner Rogers |
Corporate Director |
Jan 1, 2022 | |
| Richard Carrico |
Corporate Officer |
Apr 12, 2023 | |
| Christion Hutson |
Corporate Director |
Jan 1, 2026 | |
| Janet Norton |
Corporate Officer |
Jan 1, 2013 | |
| Frank Purdy |
Corporate Director |
Jan 1, 2022 | |
| Victoria Buster |
Corporate Director |
Jan 1, 2023 | |
| Danyel D Clay |
Corporate Officer |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 | ||
| Isaac J Myers |
Corporate Officer |
Jan 10, 2018 | |
| Susan S Tamme |
Corporate Director |
Jan 1, 2026 | |
| Joanne M Berryman |
Corporate Director |
Jan 1, 2024 | |
| Baptist Healthcare System Inc |
5% Or Greater Direct Ownership Interest | Aug 5, 2019 | 100% |
| Ronald Douglas Reed |
Corporate Officer |
Jan 17, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070228000503 | KY | Part B Supplier - Clinic/Group Practice | 5597867184 |
Receives reassigned benefits from 1,548 practitioners 40 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20190806003654 | KY | Part a Provider - Rural Health Clinic | 5597867184 | Practice locations: Benton, KY |
National Provider Directory
- Part of
- Baptist Health Inc
Locations
200 Clinic Dr
Madisonville, KY 42431
Phone (270) 821-8874
2601 Kentucky Ave
Ste 401
Paducah, KY 42003
Phone (270) 444-8200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
543 Powell LN
Benton, KY 42025-5366
Mailing address
1901 Campus PL
Louisville, KY 40299-2308
Phone (502) 253-4911
Other names
- Benton Rural Health Clinic
Other providers in Benton, KY
- Staci Anderson
- Theresa Angle
- Ashby Group, LLC
- Jonathan Bailey
- Emma Beth Ballard
- William J Barabas
- Macey Nicole Barnard
- Barrett Chiropractic Center, Inc.
- Barrett Therapy and Wellness PLLC
- James Robert Barrett
All providers in Benton, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.