Deaconess Hospital, Inc
Organization Active NPI Internal Medicine Physician · Princeton, IN
NPI 1023052883 · NPPES record last updated Oct 19, 2007
Key facts
- NPI
- 1023052883
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- DEACONESS HOSPITAL, INC
- Practice address
- 105 N 2ND Ave
Princeton, IN 47670-1005 - Phone
- (812) 386-6560
- Fax
- (812) 385-5015
- NPI assigned
- Jun 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Richard M Stivers
- Title
- Sr Vice President, Cfo
- Phone
- (812) 450-3296
Other NPIs on the same Medicare enrollment 43
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040115000129 | IN | Part B Supplier - Clinic/Group Practice | 9032021431 |
Receives reassigned benefits from 719 practitioners 43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Evansville, IN; Newburgh, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
105 N 2ND Ave
Princeton, IN 47670-1005
Mailing address
PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-6815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CG1119 | Other | IN | RR MCARE GROUP # |
Other names
- Deaconess Medical Group - Princeton
NPI Registry JSON
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1192752000000",
"number": "1023052883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3407",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477333407",
"telephone_number": "812-450-6815",
"fax_number": "812-450-6822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 N 2ND AVE",
"city": "PRINCETON",
"state": "IN",
"postal_code": "476701005",
"telephone_number": "812-386-6560",
"fax_number": "812-385-5015"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DEACONESS HOSPITAL, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-15",
"last_updated": "2007-10-19",
"status": "A",
"authorized_official_last_name": "STIVERS",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "SR VICE PRESIDENT, CFO",
"authorized_official_telephone_number": "812-450-3296"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MCARE GROUP #",
"identifier": "CG1119",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Deaconess Medical Group - Princeton",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Princeton, IN
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
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- Deaconess Clinic, Inc.
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- Deaconess Hospital, Inc
- Deaconess Hospital, Inc
- Deaconess Hospital, Inc
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- Deaconess Specialty Physicians, Inc
All providers in Princeton, IN · Internal Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2007. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.