Details | Entity Name | Update | Change Request | BAPTIST HOSPITAL OF MIAMI, INC | Baptist Hospital of Miami, INC | 3/20/2025 2:03 PM |
Details | Last Recertification Date | Update | Recertification | 9/1/2023 3:03:30 PM | 8/28/2024 1:55:07 PM | 8/28/2024 1:55 PM |
Addresses | Billing Address | Update | Change Request | Country Walk UCC
Baptist Health South Florida Accounts Payable
PO Box 29002
Miami, FL 33102 | Country Walk UCC
Baptist Health South Florida Accounts Payable
8900 North Kendall Drive
Miami, FL 33176 | 7/29/2024 3:43 PM |
Addresses | Billing Address | Update | Change Request | Country Walk UCC - BHSF Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197 | Country Walk UCC
Baptist Health South Florida Accounts Payable
PO Box 29002
Miami, FL 33102 | 2/14/2024 1:02 PM |
Addresses | Billing Address | Update | Recertification | Country Walk UCC - BHSF Accounts Payable
8900 North Kendall Drive
Hollywood, FL 33020-2197 | Country Walk UCC - BHSF Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197 | 9/1/2023 3:03 PM |
Details | Last Recertification Date | Update | Recertification | 9/19/2022 7:41:02 AM | 9/1/2023 3:03:30 PM | 9/1/2023 3:03 PM |
Addresses | Shipping Address | Delete | Change Request | Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
9001 NW 33rd Street
Doral, FL 33172 | | 2/13/2023 8:26 AM |
Addresses | Shipping Address | Insert | Change Request | | Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
14408 Commerce Way
Miami Lakes, FL 33016 | 10/21/2022 7:42 AM |
Addresses | Billing Address | Update | Change Request | Country Walk UCC - BHSF Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197 | Country Walk UCC - BHSF Accounts Payable
8900 North Kendall Drive
Hollywood, FL 33020-2197 | 10/21/2022 7:42 AM |
Addresses | Shipping Address | Delete | Recertification | Baptist Hospital of Miami
Country Walk Urgent Care Center
13500 SW 152 Street
Suite 100
Miami, FL 33177 | | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Recertification | | Baptist Hospital of Miami
Country Walk Urgent Care Center
13500 SW 152 Street
100
Miami, FL 33177 | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Recertification | | RedPharm Drug
6501 City West Pkwy
Eden Prairie, MN 55344 | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Recertification | | EPM Packaging Inc
210 E 4th Street
Lexington, NE 68850 | 9/19/2022 7:41 AM |
Addresses | Main Address | Update | Recertification |
13500 SW 152 Street
Suite 100
Miami, FL 33177 |
13500 SW 152 Street
100
Miami, FL 33177 | 9/19/2022 7:41 AM |
Details | Last Recertification Date | Update | Recertification | 9/11/2021 2:33:01 PM | 9/19/2022 7:41:02 AM | 9/19/2022 7:41 AM |
Details | Entity Subname | Update | Recertification | Country Walk Urgent Care Center | Urgent Care Center - Country Walk | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Change Request | | Baptist Hospital of Miami
Country Walk Urgent Care Center
13500 SW 152 Street
Suite 100
Miami, FL 33177 | 6/6/2022 4:21 PM |
Addresses | Shipping Address | Insert | Change Request | | Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
9001 NW 33rd Street
Doral, FL 33172 | 6/6/2022 4:21 PM |
Details | Last Recertification Date | Update | Recertification | 8/18/2020 6:32:02 PM | 9/11/2021 2:33:01 PM | 9/11/2021 2:33 PM |
Contacts | Authorizing Official | Update | Profile Change Request | Camejo, Madeline
Vice President and Chief Pharmacy Officer
Baptist Health South Florida
7865951130 | Camejo, Madeline
Vice President and Chief Pharmacy Officer
Baptist Health South Florida
7866620801 | 9/10/2021 4:10 PM |
Medicaid Billing | NPI: State | Update | Recertification | | FL | 8/18/2020 6:32 PM |
Details | Last Recertification Date | Update | Recertification | 8/30/2019 9:56:12 AM | 8/18/2020 6:32:02 PM | 8/18/2020 6:32 PM |
Contacts | Primary Contact | Update | Profile Change Request | Marcelin, Halena Leah
Director, Pharmacy Business Affairs
Baptist Health South Florida
7866620785 | Marcelin, Halena Leah
Director, Pharmacy Business Affairs
Baptist Health South Florida
7866620805 | 5/27/2020 8:26 PM |
Details | Last Recertification Date | Update | Recertification | 9/12/2018 12:34:07 PM | 8/30/2019 9:56:12 AM | 8/30/2019 9:56 AM |
Contacts | Primary Contact | Update | Recertification | Rouseff, Maribeth
Assistant VP
Baptist Health South Florida
7865963330 | Marcelin, Halena Leah
Director, Pharmacy Business Affairs
Baptist Health South Florida
7866620785 | 9/12/2018 12:34 PM |
Details | Last Recertification Date | Update | Recertification | 12/6/2017 11:48:17 AM | 9/12/2018 12:34:07 PM | 9/12/2018 12:34 PM |
Contacts | Authorizing Official | Update | AO Change Request | Thomson Quintero, Suzzanne
Chief Procurement Office and Corporate Vice President
Baptist Hospital Of Miami
7866627866 | Camejo, Madeline
Vice President and Chief Pharmacy Officer
Baptist Health South Florida
7865951130 | 8/24/2018 11:30 AM |
Details | Last Recertification Date | Update | Recertification | 8/11/2016 12:00:00 AM | 12/6/2017 11:48:17 AM | 12/6/2017 11:48 AM |
Details | Entity Name | Update | Recertification | BAPTIST HOSPITAL | BAPTIST HOSPITAL OF MIAMI, INC | 12/6/2017 11:24 AM |
Contacts | Primary Contact | Update | Profile Change Request | Rouseff, Maribeth
Assistant VP
Baptist Hospital of Miami, Inc
7865963330 | Rouseff, Maribeth
Assistant VP
Baptist Health South Florida
7865963330 | 11/21/2017 1:42 PM |
Contacts | Authorizing Official | Insert | AO Change Request | | Thomson Quintero, Suzzanne
Chief Procurement Office and Corporate Vice President
Baptist Hospital Of Miami
7866627866 | 10/18/2017 9:10 AM |
Contacts | Primary Contact | Update | | Rouseff, Maribeth
Assistant VP
7865963330 | Rouseff, Maribeth
Assistant VP
Baptist Hospital of Miami, Inc
7865963330 | 9/21/2017 10:45 AM |
Contacts | Primary Contact | Insert | | | Rouseff, Maribeth
Assistant VP
7865963330 | 6/12/2017 11:16 AM |
Contacts | Signed By | Insert | | | BOULENGER, BO
CEO
7865966503 | 6/12/2017 11:16 AM |
Addresses | Main Address | Insert | | |
13500 SW 152 Street
Suite 100
Miami, FL 33177 | 8/11/2016 3:39 PM |
Details | Last Recertification Date | Update | | | 8/11/2016 12:00:00 AM | 8/11/2016 3:39 PM |
Addresses | Billing Address | Insert | | | Country Walk UCC - BHSF Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197 | 8/3/2016 8:39 AM |
Dates | Participating Approval Date | Update | | | 5/5/2016 12:00:00 AM | 5/5/2016 1:23 PM |
Details | State | Update | | Pending | Active | 5/5/2016 1:23 PM |
Dates | Start Date | Update | | | 7/1/2016 12:00:00 AM | 5/5/2016 1:23 PM |
Details | 340B ID | Update | | DSH10008G | DSH100008G | 5/3/2016 3:32 PM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_60035 | DSH10008G | 4/29/2016 7:47 AM |
Details | Entity Subname | Update | | Country Walk UCC | Country Walk Urgent Care Center | 4/29/2016 7:47 AM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_60035 | 4/13/2016 1:13 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/13/2016 1:13 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 010035800 | 4/13/2016 1:13 PM |
Medicaid Billing | Medicaid: State | Insert | | | FL | 4/13/2016 1:13 PM |
Medicaid Billing | NPI: Number | Insert | | | 1528042884 | 4/13/2016 1:13 PM |
Details | Last Recertification Date | Insert | | | | 4/13/2016 1:13 PM |
Details | Grant Number | Insert | | | | 4/13/2016 1:13 PM |
Details | 340B ID | Insert | | | | 4/13/2016 1:13 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 4/13/2016 1:13 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/13/2016 1:13 PM |
Details | Medicare Provider Number | Insert | | | 100008 | 4/13/2016 1:13 PM |
Details | Entity Name | Insert | | | BAPTIST HOSPITAL | 4/13/2016 1:13 PM |
Details | Program Code | Insert | | | DSH | 4/13/2016 1:13 PM |
Details | Entity Subname | Insert | | | Country Walk UCC | 4/13/2016 1:13 PM |
Dates | Participating Approval Date | Insert | | | | 4/13/2016 1:13 PM |
Details | State | Insert | | | Pending | 4/13/2016 1:13 PM |
Dates | Registration Date | Insert | | | 4/13/2016 12:00:00 AM | 4/13/2016 1:13 PM |
Dates | Signed By Date | Insert | | | 4/13/2016 12:00:00 AM | 4/13/2016 1:13 PM |
Dates | Start Date | Insert | | | | 4/13/2016 1:13 PM |
Terminations | Termination Comments | Insert | | | | 4/13/2016 1:13 PM |
Terminations | Termination Date | Insert | | | | 4/13/2016 1:13 PM |
Terminations | Termination Effective Date | Insert | | | | 4/13/2016 1:13 PM |
Terminations | Termination Reason | Insert | | | | 4/13/2016 1:13 PM |