NPIMap

Organization Active NPI

Northwest Florida Healthcare, Inc

  • Skilled Nursing Facility
  • Chipley, FL
National Provider Identifier
1942367057
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
4005 Issued in FL
Legal business name
NORTHWEST FLORIDA HEALTHCARE, INC
Practice address
1360 Brickyard Rd
Chipley, FL 32428-6303
Phone
(850) 638-1610
Fax
(850) 638-5764
NPI assigned
Jan 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gregg J Moreau
Title
Cfo & Coo
Phone
(850) 415-8197

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 4005 FL Primary

Addresses

Primary practice location

1360 Brickyard Rd
Chipley, FL 32428-6303

Mailing address

1360 Brickyard Rd
Chipley, FL 32428-6303
Phone (850) 638-1610

Other identifiers 1

IdentifierTypeStateIssuer
594OtherFLBLUE CROSS

Other names 1

  • Northwest Florida Community Hospital SNU Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000004 FL Part A Provider - Skilled Nursing Facility 2668363771 Practice locations: Chipley, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942367057. Details of each certification follow.

Skilled nursing facility certification: CCN 106055

Legal name
NORTHWEST FLORIDA HEALTHCARE, INC.
Doing business as
NORTHWEST FLORIDA COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Mar 6, 2003
Last certification
Sep 24, 2024
Beds
34
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Sep 22, 2003 in FL
Enrollment address
1360 Brickyard Rd
Chipley, FL 32428-6303
Nursing home name
NORTHWEST FLORIDA COMMUNITY HOSPITAL (SNU)

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Northwest Florida Community Hospital (Snu)CCN 106055 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Mar 6, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3432.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Northwest Florida Healthcare Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 5

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 OfficerPresident Dec 21, 2012
NFCH, Inc Organization, Los Angeles, CA Created for acquisition, For-profit 5% Or Greater Direct Ownership Interest Dec 21, 2012 100%
Steven Lisenby Individual Corporate OfficerCfo Sep 21, 2020
James Allen Clemmons Individual Adp of the SNF Aug 10, 2023
Michael Andrew Kozar Individual Corporate OfficerChief Executive Officer Jan 4, 2016
Operational/Managerial Control Jan 4, 2016
Adp of the SNF Jun 16, 2025

Owners & managing parties with NPI records 1

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
Northwest Florida Healthcare, Inc.Vernon, FL, CCN 103450 Rural health clinic 5% Or Greater Direct Ownership Interest Jun 1, 2011
Family Healthcare of ChipleyChipley, FL, CCN 103995 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2016
Graceville Clinic - Northwest Florida Community HospitalGraceville, FL, CCN 103457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
Bailey Family Practice - Northwest Florida Community HospitalBonifay, FL, CCN 108501 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2019

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 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942367057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 BRICKYARD RD",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324286303",
            "telephone_number": "850-638-1610",
            "fax_number": "850-638-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 BRICKYARD RD",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324286303",
            "telephone_number": "850-638-1610",
            "fax_number": "850-638-5764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FLORIDA HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOREAU",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO & COO",
        "authorized_official_telephone_number": "850-415-8197"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "4005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "594",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Florida Community Hospital SNU",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chipley, FL

Sources for this page

Verify at the official NPI Registry.