Union Hospital Inc
Organization Active NPI Rural Health Clinic/Center · Brazil, IN
NPI 1013087048 · NPPES record last updated Jul 20, 2023
Key facts
- NPI
- 1013087048
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- UNION HOSPITAL INC
- Practice address
- 115 S Murphy Ave
Ste a
Brazil, IN 47834-8296 - Phone
- (812) 442-2100
- NPI assigned
- Nov 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Steve Holman
- Title
- Ceo
- Phone
- (812) 238-7606
Owners & managing parties with NPI records 10
-
Kathleen D Coutinho, M.D.
-
Kenneth Masaka Kigorwe, M.D.
Owned or controlled facilities with NPI records 9
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 28
Member of 1
Facilities with the same owner 7
Practitioners 99
-
Alexa Ann Bigger, FNP
-
Emily A Bradshaw, NURSE PRACTITIONER
-
David Allen Breitweiser, M.D.
-
Kendal R. Carpenter, PA-C
-
Elizabeth Ann Hines, APRN,BC
-
Daniel P Kellar, MD
-
Amy Elizabeth Koch, FNP
-
Alexandra Miller, PA-C
-
Alyssa D Robinson, NURSE PRACTITIONER
-
Mark J Schuld, MD
-
Vishal Viswam, M.D.
-
Amy C James, MD
-
Joseph Y Abdayem, M.D.
-
Michael D Allen, M.D.
-
Eric D. Beachy, MD
-
Janie Bennett, LCSW
-
Darla Jo Berry, CNM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0933462 | Brazil Family Medicine | Provider-performed microscopy | Sep 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Rural health clinic certification: CCN 153869
- Legal name
- UNION HOSPITAL INC
- Doing business as
- BRAZIL FAMILY MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 7, 2003
- Last certification
- Aug 11, 2021
- Ownership / control type
- 2B
- Most recent change of ownership
- Sep 30, 2016 (2 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 6, 1895 in IN
- Enrollment address
- 115 S Murphy Ave
Ste a
Brazil, IN 47834-8296
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| John Aidoo |
Corporate Director |
Jan 1, 2021 | |
| Mary Doti |
Corporate Director |
Jan 1, 2018 | |
| Tim Sullivan |
Corporate Officer |
Jan 1, 2021 | |
| Corporate Director |
Jan 1, 2021 | ||
| Robert a Coons |
Corporate Officer |
Oct 1, 2016 | |
| Corporate Director |
Oct 23, 2014 | ||
| John C Etling |
Corporate Director |
Jan 1, 2019 | |
| Kenneth M Kigorwe |
Other |
Jan 1, 2023 | |
| Luke Terry |
Corporate Officer |
Jan 1, 2021 | |
| Corporate Director |
Jan 1, 2021 | ||
| Kathleen D Coutinho |
Corporate Director |
Jan 1, 2019 | |
| Donald T Scott |
Corporate Director |
Oct 23, 2014 | |
| Steven M Holman |
Corporate Director |
Apr 30, 2014 | |
| W-2 Managing Employee |
Apr 30, 2014 | ||
| Richard Templeton |
Other |
Jan 1, 2024 | |
| Sara D Smith |
Corporate Officer |
Oct 1, 2016 | |
| Corporate Director |
Oct 23, 2014 | ||
| Molly a Callahan |
Corporate Director |
Oct 1, 2005 | |
| Union Hospital Inc |
5% Or Greater Direct Ownership Interest | Sep 30, 2016 | 100% |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Union Hospital Clinton |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 27, 2005 |
| Union Hospital Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1966 |
| Union Hospital Medical Rehabilitation Unit |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 1989 |
| Union Hospital Clinton |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Dec 27, 2005 |
| Union Hospital Inc |
Hospital | 5% Or Greater Indirect Ownership Interest | Jan 1, 1966 |
| Cork Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2001 |
| Clay City Center for Family Medicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Dec 10, 1993 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Sep 30, 2016 | Change of Ownership |
Brazil Family Medicine |
| Sep 30, 2016 | Change of Ownership |
Brazil Family Medicine |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040519000807 | IN | Part B Supplier - Clinic/Group Practice | 8426943614 |
Receives reassigned benefits from 126 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Terre Haute, IN; W Terre Haute, IN; Brazil, IN; Clay City, IN; Clinton, IN; Greencastle, IN; Riley, IN; Rockville, IN… |
| O20170223001026 | IN | Part a Provider - Rural Health Clinic | 8426943614 | Practice locations: Brazil, IN |
National Provider Directory
- Tax ID family
- Bala C Rangaswami MD
Locations
1530 N 7th St
Ste 110
Terre Haute, IN 47807
Phone (812) 238-7878
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | IN | Yes |
Addresses
Primary practice location
115 S Murphy Ave
Ste a
Brazil, IN 47834-8296
Mailing address
221 S 6TH St
Terre Haute, IN 47807-4214
Phone (812) 242-3157
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200853600A | Medicaid | IN |
Other names
- Brazil Family Medicine
Other providers in Brazil, IN
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- Betsy Ummel
- Union Associated Physicians Clinic, LLC
- US PT Turnkey Services Inc.
- Karen Vitz
- Wabash Valley Internal Medicine LLC
- Wabash Valley Midwives
- Wal-Mart Stores East LP
All providers in Brazil, IN · Rural Health Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.