NPIMap

Organization Active NPI

Northwest Florida Healthcare, Inc.

Doing business as Bailey Family Practice - Northwest Florida Community Hospital

  • Rural Health Clinic/Center
  • Bonifay, FL
National Provider Identifier
1528691102
Registry record updated Feb 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHWEST FLORIDA HEALTHCARE, INC.
Doing business as
Bailey Family Practice - Northwest Florida Community Hospital
Practice address
101 E Wisconsin Ave
Bonifay, FL 32425-1809
Phone
(850) 547-2209
Fax
(850) 547-4521
NPI assigned
Feb 21, 2020
Last updated
Feb 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST FLORIDA HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2020

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

Authorized official

Name
Marcey Lynn Morgan
Title
Senior Accountant
Phone
(850) 415-8127

Specialties & licenses 1

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

Addresses

Primary practice location

101 E Wisconsin Ave
Bonifay, FL 32425-1809

Mailing address

1360 Brickyard Rd
Chipley, FL 32428-6303
Phone (850) 415-8127

Other names 1

  • Bailey Family Practice - Northwest Florida Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200303000431 FL Part A Provider - Rural Health Clinic 2668363771 Practice locations: Bonifay, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528691102. Details of each certification follow.

Rural health clinic certification: CCN 108501

Legal name
NORTHWEST FLORIDA HEALTHCARE, INC.
Doing business as
BAILEY FAMILY PRACTICE - NORTHWEST FLORIDA COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 10, 2021
Last certification
May 10, 2021
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 22, 2003 in FL
Enrollment address
101 E Wisconsin Ave
Bonifay, FL 32425-1809
Related CCNs
101308

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Northwest Florida Healthcare Inc10 organizations share this tax ID, including this one
Part of
Northwest Florida Healthcare Inc

Other organizations with this tax ID 9

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Northwest Florida Healthcare, Inc. Organization, Chipley, FL Corporation, For-profit 5% Or Greater Direct Ownership Interest Jul 15, 2019 100%
Ira Smedra Individual Corporate OfficerPresident Jul 15, 2019
Steven Lisenby Individual Corporate Officer Sep 21, 2020
Michael Andrew Kozar Individual Contracted Managing EmployeeCeo Jul 15, 2019
Corporate OfficerChief Executive Officer Jul 15, 2019

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Northwest Florida Healthcare, Inc.Vernon, FL, CCN 103450 Rural health clinic 5% Or Greater Direct Ownership Interest Jun 1, 2011
Family Healthcare of ChipleyChipley, FL, CCN 103995 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2016
Graceville Clinic - Northwest Florida Community HospitalGraceville, FL, CCN 103457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017

Owned or controlled facilities with NPI records 3

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

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": "1582243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582243200000",
    "number": "1528691102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 BRICKYARD RD",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324286303",
            "telephone_number": "850-415-8127",
            "fax_number": "850-638-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E WISCONSIN AVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324251809",
            "telephone_number": "850-547-2209",
            "fax_number": "850-547-4521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FLORIDA HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST FLORIDA HEALTHCARE, INC.",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "MARCEY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "SENIOR ACCOUNTANT",
        "authorized_official_telephone_number": "850-415-8127"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bailey Family Practice - Northwest Florida Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonifay, FL

Sources for this page

Verify at the official NPI Registry.