NPIMap

Organization Active NPI

Rural Primary Care South-Walton, Inc.

  • Internal Medicine Physician
  • Santa Rosa Beach, FL
National Provider Identifier
1912545955
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RURAL PRIMARY CARE SOUTH-WALTON, INC.
Practice address
5551 US Highway 98
Suite 2
Santa Rosa Beach, FL 32459
Phone
(850) 420-5420
Fax
(850) 244-8011
NPI assigned
Dec 19, 2019
Last updated
Feb 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Authorized official

Name
Amanda Patton, RN
Title
Practice Manager
Phone
(850) 420-5420

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Internal Medicine Physician 207R00000X Primary
General Practice Physician 208D00000X

Addresses

Primary practice location

5551 US Highway 98
Suite 2
Santa Rosa Beach, FL 32459

Mailing address

5551 US Highway 98
Suite 2
Santa Rosa Beach, FL 32459
Phone (850) 420-5420

Other identifiers 1

IdentifierTypeStateIssuer
110818301MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200617000015 FL Part A Provider - Rural Health Clinic 0446672653 Practice locations: Santa Rosa Beach, FL
O20210609002544 FL Part B Supplier - Clinic/Group Practice 0446672653 Receives reassigned benefits from 4 practitioners
Practice locations: Santa Rosa Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912545955. Details of each certification follow.

Rural health clinic certification: CCN 683845

Legal name
RURAL PRIMARY CARE SOUTH-WALTON, INC.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 28, 2022
Last certification
Dec 28, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Enrollment address
5551 US Highway 98 W
Ste 2
Santa Rosa Beach, FL 32459-3566

National Provider Directory

National Provider Directory

Locations

5551 US Highway 98 W
Ste 2
Santa Rosa Beach, FL 32459
Phone (205) 563-6931

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Michael T Patton Individual 5% Or Greater Direct Ownership Interest Dec 12, 2019 100%
Corporate OfficerPresident Dec 12, 2019 100%
W-2 Managing EmployeePresident Dec 12, 2019 100%
Operational/Managerial ControlPresident Dec 12, 2019 100%

Owners & managing parties with NPI records 1

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

  • Michael T Patton, D.O.
    • Internal Medicine Physician
    • Santa Rosa Beach, FL
    • NPI 1245200633

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1912545955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5551 US HIGHWAY 98",
            "address_2": "SUITE 2",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "32459",
            "telephone_number": "850-420-5420",
            "fax_number": "850-244-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5551 US HIGHWAY 98",
            "address_2": "SUITE 2",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "32459",
            "telephone_number": "850-420-5420",
            "fax_number": "850-244-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL PRIMARY CARE SOUTH-WALTON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-19",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "850-420-5420",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110818301",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa Beach, FL

Sources for this page

Verify at the official NPI Registry.