NPIMap

Organization Active NPI

Baptist Health Deaconess Medical Group Inc

  • Rural Health Clinic/Center
  • Powderly, KY
National Provider Identifier
1558942011
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST HEALTH DEACONESS MEDICAL GROUP INC
Practice address
1010 Medical Center Dr
Powderly, KY 42367-5463
Phone
(270) 377-1600
Fax
(270) 338-0229
NPI assigned
Apr 16, 2021
Last updated
Apr 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Authorized official

Name
Danyel D Clay
Title
Executive Director Revenue Cycle
Phone
(502) 253-4911

Specialties & licenses 1

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

Addresses

Primary practice location

1010 Medical Center Dr
Powderly, KY 42367-5463

Mailing address

2701 Eastpoint Pkwy
Louisville, KY 40223-4166
Phone (502) 253-4911

Other names 1

  • Powderly RHC Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210810000993 KY Part B Supplier - Clinic/Group Practice 6103220330 Receives reassigned benefits from 322 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Princeton, KY; Dawson Springs, KY; Powderly, KY; Madisonville, KY; Hopkinsville, KY; Clay, KY
O20220405000344 KY Part A Provider - Rural Health Clinic 6103220330 Practice locations: Powderly, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558942011. Details of each certification follow.

Rural health clinic certification: CCN 183950

Legal name
BAPTIST HEALTH DEACONESS MEDICAL GROUP INC
Doing business as
POWDERLY RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 15, 2007
Last certification
Oct 28, 2016
Ownership / control type
2B
Most recent change of ownership
Aug 2, 2016 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 2021 in KY
Enrollment address
1010 Medical Center Dr
Powderly, KY 42367-5463

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Baptist Health Deaconess, LLC Organization, Louisville, KY Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2021
Marc J Florence Individual Corporate DirectorDirector Sep 1, 2021
Richard Carrico Individual Corporate OfficerVice President Apr 12, 2023
Lynn C Lingafelter Individual Corporate DirectorDirector Sep 1, 2021
Danyel D Clay Individual Corporate OfficerVice President Sep 1, 2021
W-2 Managing EmployeeVice President Sep 1, 2021
Isaac J Myers Individual Corporate DirectorDirector Sep 1, 2023
Joseph W Prather Individual Corporate OfficerChief Strategy & Marketing Officer Sep 1, 2021
Valarie Howard Individual Corporate OfficerCfo May 1, 2025
Shawn W McCoy Individual Corporate DirectorDirector Sep 1, 2021
Patrick Falvey Individual Corporate OfficerChief Operating Officer Sep 1, 2021
James Porter Individual Corporate DirectorDirector Sep 1, 2021

Facilities with the same owner 11

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

Change-of-ownership history 1

DateEventCounterparty
Sep 1, 2021 Change of OwnershipThis provider was the buyer Baptist Primary Care of PowderlyCCN 183950, KY, NPI 1477048684

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1558942011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 EASTPOINT PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402234166",
            "telephone_number": "502-253-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 MEDICAL CENTER DR",
            "city": "POWDERLY",
            "state": "KY",
            "postal_code": "423675463",
            "telephone_number": "270-377-1600",
            "fax_number": "270-338-0229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST HEALTH DEACONESS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "CLAY",
        "authorized_official_first_name": "DANYEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "502-253-4911"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powderly RHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Powderly, KY

Sources for this page

Verify at the official NPI Registry.