NPIMap

Organization Active NPI

Southern Baptist Hospital of Florida Inc

  • General Acute Care Hospital
  • Jacksonville, FL
National Provider Identifier
1578620449
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
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) 202-2092
Fax
(904) 376-4280
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 4448 FL Primary
Children's Hospital 282NC2000X 4448 FL

Addresses

Primary practice location

800 Prudential Dr
Jacksonville, FL 32207-8202

Mailing address

PO Box 45094
Jacksonville, FL 32232-5094
Phone (904) 202-2092

Other identifiers 4

IdentifierTypeStateIssuer
00103771AMedicaidGA
010064102MedicaidFL
BLUE CROSS OF FLOtherFL120
010064100MedicaidFL

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 FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071003000559 FL Part A Provider - Hospital 9032106190
O20071222000051 FL Part A Provider - Hospital 9032106190 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jacksonville, FL

Hospital certification: CCN 100088

Legal name
SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 10, 2002
Beds
1,229
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1965 in FL
Enrollment address
800 Prudential Dr
Jacksonville, FL 32207-8202
Main/Primary Hospital Location
Hospital subgroups
Acute care

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Baptist Health Medical Center - JacksonvilleCCN 100088
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 4

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

Locations

841 Prudential Dr
Unit 1602
Jacksonville, FL 32207

800 Prudential Dr
Bldg B
Jacksonville, FL 32207

400 Colonnade Dr
Ste 150
Ponte Vedra, FL 32081
Phone (904) 271-7520

Ownership & related parties

All disclosed owners & managing parties 27

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 Mar 1, 2018
Corporate DirectorBoard Member May 13, 2013
Michael J Erhard Individual Corporate DirectorBoard Member Mar 1, 2016
Philip Boyce Individual Corporate OfficerVP & Chief Revenue Officer Jan 1, 2020
Corporate OfficerSVP & Chief Revenue Officer Jan 1, 2020
Asghar a Syed Individual Corporate DirectorBoard Member Mar 1, 2020
Rachael T Fortune Individual Corporate DirectorBoard Member Mar 1, 2023
Cleve E Warren Individual Corporate DirectorBoard Member Mar 1, 2021
Baptist Health System Inc Organization, Jacksonville, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 1, 2000 100%
5% Or Greater Direct Ownership Interest Aug 29, 1983 100%
Kyle P Etzkorn Individual Corporate DirectorBoard Member Mar 1, 2022
Michael K Diaz Individual Corporate DirectorBoard Member Mar 1, 2024
Deborah Pass Durham Individual Corporate DirectorBoard Member Mar 1, 2019
Clint D Drawdy Individual Corporate DirectorBoard Member Mar 1, 2024
Kristi N Garside Individual Corporate DirectorBoard Member Mar 1, 2019
Pamela Chally Individual Corporate DirectorBoard Member Mar 1, 2014
Corporate DirectorBoard Member Mar 3, 2012
Matthew Zuino Individual Corporate OfficerHospital President, Ceo Jan 17, 2026
W-2 Managing EmployeeHospital President, Ceo Jan 17, 2026
John Anderson Individual Corporate DirectorBoard Member Mar 1, 2024
Ilene Levenson Individual Corporate DirectorBoard Member Mar 1, 2023
Mark R Laborde Individual Corporate DirectorBoard Member Mar 1, 2023
Diane S Raines Individual Corporate DirectorBoard Member Mar 1, 2024
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
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
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 2

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.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

Affiliated clinicians 2,415

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 2,415

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1578620449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45094",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322325094",
            "telephone_number": "904-202-2092",
            "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": "904-202-2092",
            "fax_number": "904-376-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "4448",
            "primary": true
        },
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "FL",
            "license": "4448",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00103771A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064102",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "120",
            "identifier": "BLUE CROSS OF FL",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064100",
            "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.