NPIMap

Organization Active NPI

Bay County Health System, LLC

Doing business as Ascension Sacred Heart Bay

  • General Acute Care Hospital
  • Panama City, FL
National Provider Identifier
1720078041
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
3982 Issued in FL
Legal business name
BAY COUNTY HEALTH SYSTEM, LLC
Doing business as
Ascension Sacred Heart Bay
Practice address
615 N Bonita Ave
Panama City, FL 32401-3623
Phone
(850) 747-1511
Fax
(850) 747-6842
NPI assigned
Oct 27, 2005
Last updated
Mar 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BAY COUNTY HEALTH SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Authorized official

Name
Stephan Frank Quiriconi
Title
Cfo
Phone
(904) 308-1258

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 3982 FL Primary
Ambulance 341600000X 2896 FL

Addresses

Primary practice location

615 N Bonita Ave
Panama City, FL 32401-3623

Mailing address

615 N Bonita Ave
Panama City, FL 32401-3623
Phone (850) 747-6045

Other identifiers 7

IdentifierTypeStateIssuer
056445100MedicaidFL
162945400OtherFLUS DEPT OF LABOR
033526600MedicaidFL
088052300MedicaidFL
419OtherFLBLUE CROSS PROVIDER NUMBE
596001478OtherFLTRICARE
010006400MedicaidFL

Other names 1

  • Ascension Sacred Heart Bay Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120912000872 FL Part A Provider - Hospital 4486816576 Practice locations: Panama City, FL; Panama City Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720078041. Details of each certification follow.

Hospital certification: CCN 100026

Legal name
BAY COUNTY HEALTH SYSTEM LLC
Doing business as
ASCENSION SACRED HEART BAY
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 4, 2021
Beds
323
Ownership / control type
Private (not for profit)
Most recent change of ownership
Apr 1, 2012 (2 total)
Organization structure
LLCNon-profit
Enrollment address
615 N Bonita Ave
Panama City, FL 32401-3623
Main/Primary Hospital Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension Sacred Heart BayCCN 100026 · All quality measures
Overall star rating
3 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
Part of
Bay County Health System LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Coba Cornejo Individual Corporate OfficerCoo Mar 14, 2019
W-2 Managing EmployeeCoo Mar 14, 2019
Operational/Managerial ControlCoo Mar 14, 2019
Don King Individual Corporate OfficerCeo Jul 1, 2022
W-2 Managing Employee Jul 1, 2022
Operational/Managerial ControlCeo Jul 1, 2022
Sacred Heart Health System Inc Organization, Pensacola, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 28, 2020 100%
Operational/Managerial Control Jul 28, 2020
Patrick George Individual Corporate OfficerCfo Dec 4, 2025
W-2 Managing EmployeeCfo Dec 4, 2025
Operational/Managerial ControlCfo Dec 4, 2025
Robin Godwin Individual Corporate OfficerPresident Jun 13, 2021
W-2 Managing EmployeePresident Jun 13, 2021
Operational/Managerial ControlPresident Jun 13, 2021
Carmon Bass Individual Corporate DirectorDirector, Net Revenue Management Jun 24, 2015

Owners & managing parties with NPI records 6

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

Affiliated clinicians 576

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

View all 576

NPI Registry JSON

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1720078041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N BONITA AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013623",
            "telephone_number": "850-747-6045",
            "fax_number": "850-763-8827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N BONITA AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013623",
            "telephone_number": "850-747-1511",
            "fax_number": "850-747-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY COUNTY HEALTH SYSTEM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY COUNTY HEALTH SYSTEM, LLC",
        "enumeration_date": "2005-10-27",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "QUIRICONI",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "904-308-1258"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "3982",
            "primary": true
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "FL",
            "license": "2896",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056445100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "162945400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033526600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088052300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "419",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "596001478",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010006400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Sacred Heart Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Panama City, FL

Sources for this page

Verify at the official NPI Registry.