NPIMap

Organization Active NPI

St Vincents Health System Inc

Doing business as Ascension St Vincent's St. Johns County

  • General Acute Care Hospital
  • Saint Johns, FL
National Provider Identifier
1861078651
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
ST VINCENTS HEALTH SYSTEM INC
Doing business as
Ascension St Vincent's St. Johns County
Practice address
205 Trinity Way
St. Johns, FL 32259
Phone
(904) 308-1255
NPI assigned
Mar 22, 2021
Last updated
Jun 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Authorized official

Name
Coba Susan Cornejo
Title
Chief Operating Officer
Phone
(850) 416-6206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

205 Trinity Way
St. Johns, FL 32259

Mailing address

4203 Belfort Rd
Jacksonville, FL 32216-1409
Phone (904) 691-1000

Other names 1

  • Ascension St Vincent's St. Johns County Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220214002347 FL Part A Provider - Hospital 7618051210 Practice locations: St Johns, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861078651. Details of each certification follow.

Hospital certification: CCN 100361

Legal name
ST. VINCENT'S HEALTH SYSTEM, INC.
Doing business as
ASCENSION ST VINCENT'S ST. JOHNS COUNTY
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Aug 29, 2022
Last certification
Aug 29, 2022
Beds
56
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 2020 in FL
Enrollment address
205 Trinity Way
St Johns, FL 32259-1155
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St Vincent's St Johns CountyCCN 100361 · All quality measures
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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2262174Ascension St Vincent's St Johns County205 Trinity Way, St Johns, FL 32259AccreditationMar 28, 2027

National Provider Directory

National Provider Directory

Member organizations 12

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

Locations

1000 Plantation Island Dr S
Saint Augustine, FL 32080
Phone (904) 239-0559

105 Nature Walk Pkwy
Unit 101
Saint Augustine, FL 32092
Phone (904) 201-4345

630 E Twincourt Trl
Ste 110111
Saint Augustine, FL 32095
Phone (904) 201-4861

2001 County Road 210 W
#100
Saint Johns, FL 32259

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jeremy Kraft Individual Corporate DirectorDirector- Net Revenue Jul 1, 2022
W-2 Managing EmployeeDirector- Net Revenue Jul 1, 2022
Helen Rowan Individual OtherChairman of the Board Jul 1, 2022
Coba Cornejo Individual Corporate OfficerChief Operating Officer Jul 1, 2022
W-2 Managing EmployeeChief Operating Officer Jul 1, 2022
Operational/Managerial ControlChief Operating Officer Jul 1, 2022
Don King Individual Corporate OfficerSenior Vice President May 1, 2023
W-2 Managing EmployeeSenior Vice President May 1, 2023
Operational/Managerial ControlSenior Vice President May 1, 2023
Patrick George Individual Corporate OfficerChief Financial Officer Jun 1, 2026
W-2 Managing EmployeeChief Financial Officer Jun 1, 2026
Operational/Managerial ControlChief Financial Officer Jun 1, 2026
Cory Darling Individual Corporate OfficerPresident May 1, 2023
W-2 Managing EmployeePresident May 1, 2023
Operational/Managerial ControlPresident May 1, 2023
St. Vincent's Health System, Inc. Organization, Jacksonville, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 6, 2022 100%

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ascension St. Vincent's SouthsideJacksonville, FL, CCN 100307 Hospital 5% Or Greater Indirect Ownership Interest (100%) Apr 12, 2008
Ascension St. Vincent's RiversideJacksonville, FL, CCN 100040 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 1966
Jul 1, 1966
Ascension St. Vincent's Clay CountyMiddleburg, FL, CCN 100321 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 6, 2012
Ascension St. Vincent's SouthsideJacksonville, FL, CCN 10T307 Hospital 5% Or Greater Indirect Ownership Interest (100%) Apr 12, 2008

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 303

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

View all 303

NPI Registry JSON

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1861078651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4203 BELFORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161409",
            "telephone_number": "904-691-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 TRINITY WAY",
            "city": "ST. JOHNS",
            "state": "FL",
            "postal_code": "32259",
            "telephone_number": "904-308-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENTS HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-22",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "COBA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "850-416-6206"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St Vincent's St. Johns County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, FL

Sources for this page

Verify at the official NPI Registry.