NPIMap

Organization Active NPI

Baptist Health Medical Group Inc

Doing business as Rural Health Clinic Williamsburg

  • Rural Health Clinic/Center
  • Williamsburg, KY
National Provider Identifier
1548755739
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900279 Issued in KY
Legal business name
BAPTIST HEALTH MEDICAL GROUP INC
Doing business as
Rural Health Clinic Williamsburg
Practice address
403 Sycamore St
Williamsburg, KY 40769-1153
Phone
(606) 549-8244
Fax
(606) 549-8354
NPI assigned
Jun 29, 2018
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Authorized official

Name
Matthew Lazari
Title
Vice President
Phone
(502) 489-8668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900279 KY Primary

Addresses

Primary practice location

403 Sycamore St
Williamsburg, KY 40769-1153

Mailing address

1901 Campus PL
Louisville, KY 40299-2308
Phone (502) 253-4911

Other identifiers 2

IdentifierTypeStateIssuer
18-8940OtherKYMEDICARE
7100336420MedicaidKY

Other names 1

  • Rural Health Clinic Williamsburg Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20150603003111 KY Part A Provider - Rural Health Clinic 5597867184 1 other NPI on this enrollment
Practice locations: Williamsburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548755739. Details of each certification follow.

Rural health clinic certification: CCN 188940

Legal name
BAPTIST HEALTH MEDICAL GROUP INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 29, 2014
Last certification
Jul 29, 2014
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2015 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2015 in KY
Enrollment address
990 S Highway 25 W
Williamsburg, KY 40769-1692

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Staci Dawn Farner Rogers Individual Corporate DirectorBoard Member Jan 1, 2022
Richard Carrico Individual Corporate OfficerVice President Apr 12, 2023
Christion Hutson Individual Corporate DirectorBoard Member Jan 1, 2026
Janet Norton Individual Corporate OfficerSecretary Jan 1, 2015
Frank Purdy Individual Corporate DirectorBoard Member Jan 1, 2022
Victoria Buster Individual Corporate DirectorBoard Member Jan 1, 2023
Danyel D Clay Individual Corporate OfficerVice President Jan 1, 2023
W-2 Managing EmployeeVice President Jan 1, 2023
Isaac J Myers Individual Corporate OfficerPresident Jan 10, 2018
Susan S Tamme Individual Corporate DirectorBoard Member Jan 1, 2026
Joanne M Berryman Individual Corporate DirectorBoard Member Jan 1, 2024
Baptist Healthcare System Inc Organization, Louisville, KY Corporation, Non-profit Operational/Managerial Control Jan 1, 2015
Ronald Douglas Reed Individual Corporate OfficerVice President Jan 17, 2024

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 29

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

View all 29

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1548755739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CAMPUS PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402992308",
            "telephone_number": "502-253-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 SYCAMORE ST",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691153",
            "telephone_number": "606-549-8244",
            "fax_number": "606-549-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-29",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "LAZARI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "502-489-8668"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "18-8940",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100336420",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Clinic Williamsburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsburg, KY

Sources for this page

Verify at the official NPI Registry.