NPIMap

Northwest Florida Healthcare, Inc.

Organization Active NPI Rural Health Clinic/Center · Chipley, FL

NPI 1740644202 · NPPES record last updated Aug 11, 2025

Key facts

NPI
1740644202
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
NORTHWEST FLORIDA HEALTHCARE, INC.
Practice address
1376 Brickyard Rd
Suite 4
Chipley, FL 32428-6391
Phone
(850) 638-0552
Fax
(850) 638-0504
NPI assigned
Apr 11, 2016
Organization subpart
Yes
Parent organization (as reported)
NORTHWEST FLORIDA HEALTHCARE, INC.

Authorized official

Name
Mr. Michael A Kozar
Title
Chief Executive Officer
Phone
(850) 415-8103

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 9

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

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

Change of ownership 1

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

Facilities with the same owner 3

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

Practitioners 37

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

View all 37

Medicare participation

Medicare fee-for-service enrollment
Enrolled in FL

Rural health clinic certification: CCN 103455

Legal name
NORTHWEST FLORIDA HEALTHCARE, INC.
Doing business as
CHIPLEY MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 19, 2017
Last certification
Mar 6, 2023
Ownership / control type
1B
Organization structure
Corporation · Proprietary
Incorporated
Sep 22, 2003 in FL
Enrollment address
1376 Brickyard Rd
Ste 3
Chipley, FL 32428-6392
Related CCNs
101308

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
Ira Smedra
Individual 		Corporate Officer
President		 Jan 1, 2016
NFCH, Inc
Organization · Davie, FL
Corporation, For-profit 		5% Or Greater Direct Ownership Interest Dec 21, 2012 100%
Steven Lisenby
Individual 		Corporate Officer
Chief Financial Officer		 Sep 21, 2020
Michael Andrew Kozar
Individual 		Contracted Managing Employee
Ceo		 Jan 1, 2016
Corporate Officer
Ceo		 Jan 1, 2016

All facility ownership & control disclosures 4

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 Chipley
Chipley, FL · CCN 103995		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2016
Graceville Clinic - Northwest Florida Community Hospital
Graceville, FL · CCN 103457		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
Bailey Family Practice - Northwest Florida Community Hospital
Bonifay, FL · CCN 108501		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2019

Change-of-ownership history

DateEventCounterparty
Mar 14, 2016 Change of Ownership
This provider was the buyer		 Chipley Medical Group
CCN 108943 · TN · NPI 1245389303

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20170803001254 FL Part a Provider - Rural Health Clinic 2668363771 Practice locations: Chipley, FL

National Provider Directory

Tax ID family
Northwest Florida Healthcare Inc (10 organizations share this tax ID)
Part of
Northwest Florida Healthcare Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

1376 Brickyard Rd
Suite 4
Chipley, FL 32428-6391

Mailing address

1376 Brickyard Rd
Suite 4
Chipley, FL 32428-6391
Phone (850) 638-0552

Other names

  • CHIPLEY MEDICAL GROUP Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 11, 2025.

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1740644202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1376 BRICKYARD RD",
            "address_2": "SUITE 4",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324286391",
            "telephone_number": "850-638-0552",
            "fax_number": "850-638-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1376 BRICKYARD RD",
            "address_2": "SUITE 4",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324286391",
            "telephone_number": "850-638-0552",
            "fax_number": "850-638-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FLORIDA HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST FLORIDA HEALTHCARE, INC.",
        "enumeration_date": "2016-04-11",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "KOZAR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "850-415-8103",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHIPLEY MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chipley, FL

All providers in Chipley, FL · Rural Health Clinic/Center in Florida

Sources for this page

Verify at the official NPI Registry.