NPIMap

Organization Active NPI

Ascension Sacred Heart Gulf

Doing business as Ascension Medical Group Sacred Heart Gulf

  • Rural Health Clinic/Center
  • Port St Joe, FL
National Provider Identifier
1912466194
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ASCENSION SACRED HEART GULF
Doing business as
Ascension Medical Group Sacred Heart Gulf
Practice address
3871 E Highway 98 Ste 201
Port St Joe, FL 32456-5302
Phone
(850) 229-3710
Fax
(850) 229-3712
NPI assigned
Mar 18, 2019
Last updated
Mar 19, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SACRED HEART HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Authorized official

Name
Miranda Hemm
Title
Enrollment Manager
Phone
(904) 450-6004

Specialties & licenses 1

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

Addresses

Primary practice location

3871 E Highway 98 Ste 201
Port St Joe, FL 32456-5302

Mailing address

PO Box 2699
Attn: SHMG/Hpe
Pensacola, FL 32513-2699
Phone (850) 229-3710

Other names 1

  • Ascension Medical Group Sacred Heart Gulf Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190326000139 FL Part A Provider - Rural Health Clinic 9830231034 Practice locations: Port St Joe, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912466194. Details of each certification follow.

Rural health clinic certification: CCN 103460

Legal name
ASCENSION SACRED HEART GULF
Doing business as
ASCENSION MEDICAL GROUP SACRED HEART GULF
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 12, 2020
Last certification
Mar 12, 2020
Ownership / control type
2B
Organization structure
CorporationProprietary
Incorporated
Aug 27, 2009 in FL
Enrollment address
3871 E Highway 98
Ste 201
Port St Joe, FL 32456-5302
Related CCNs
100313

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Sacred Heart Hospital10 organizations share this tax ID, including this one
Part of
Sacred Heart Specialty

Other organizations with this tax ID 9

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

Member of 1

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

Locations

55 Avenue E
Apalachicola, FL 32320
Phone (850) 370-1000

3871 E Highway 98
Ste 100
Port St Joe, FL 32456
Phone (850) 227-7778

3871 E Highway 98
Ste 201
Port St Joe, FL 32456
Phone (850) 229-3710

3871 E Highway 98
Ste 203
Port St Joe, FL 32456
Phone (850) 229-5661

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Miranda Hemm Individual W-2 Managing EmployeeEnrollment Director May 17, 2017
Sacred Heart Health System Inc Organization, Pensacola, FL Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2012 100%
Justin H Labrato Individual Corporate OfficerChief Operating Officer Jul 1, 2012
W-2 Managing Employee Jul 1, 2012

Owners & managing parties with NPI records 6

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

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 Sacred Heart GulfPort St Joe, FL, CCN 10U313 Hospital 5% Or Greater Direct Ownership Interest Mar 15, 2010
Ascension Sacred Heart GulfApalachicola, FL, CCN 103452 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012
Ascension Medical Group Sacred Heart GulfWewahitchka, FL, CCN 108500 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012
Ascension Medical Group Sacred Heart GulfPort St Joe, FL, CCN 103461 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1912466194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "address_2": "ATTN: SHMG/HPE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-229-3710",
            "fax_number": "850-229-3712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3871 E HIGHWAY 98 STE 201",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324565302",
            "telephone_number": "850-229-3710",
            "fax_number": "850-229-3712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASCENSION SACRED HEART GULF",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SACRED HEART HEALTH SYSTEM",
        "enumeration_date": "2019-03-18",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "HEMM",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "904-450-6004"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Medical Group Sacred Heart Gulf",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Joe, FL

Sources for this page

Verify at the official NPI Registry.