St. Joseph Health System, LLC
Organization Active NPI General Acute Care Hospital · Fort Wayne, IN
NPI 1023060472 · NPPES record last updated Dec 1, 2021
Key facts
- NPI
- 1023060472
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 05-005043-1 (IN)
- Legal business name
- ST. JOSEPH HEALTH SYSTEM, LLC
- Practice address
- 702 Van Buren St
Fort Wayne, IN 46802-3697 - Phone
- (260) 425-3000
- Fax
- (260) 425-3222
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Paula M Lalor
- Title
- Director/Delegated Official
- Phone
- (629) 215-3953
Owners & managing parties with NPI records 1
Subparts reporting this organization as parent 5
Member of 1
Member organizations 4
Facilities with the same owner 122
Practitioners 4
-
John Addo, MD
-
Barry R Marfleet, M.D.
-
Fred Shu, MD
Affiliated clinicians 145
-
Musa Abdalla, M. D.
-
Danyelle R Aber, M.D.
-
Dorothea Addo, MD
-
John Addo, MD
-
Dinesh Agnihotri, MD
-
Bhaktavatsala Rao Apuri, M.D., FACC
-
Gaurav Arora, M.D.
-
Claire Aubrey, D.O
-
Sunil Babu, M.D.
-
Joyce A. Bell, NP
-
Lucas Berghoff, D.O.
-
Ronald John Berish, M.D.
-
Zachary Biehl, M.D.
-
Carrie Jean Boots, N.P.
-
Dedrick K. Bowe, MD
-
Jacob Brown, CRNA
-
Emmanuel C. Cabe, MD
-
Matthew L Carr, MD
-
Michael R Carter, MD
-
Gage Manning Caudell, D.P.M.
-
Decoma Nicole Cavender, FNP-BC
Medicare Care Compare: Hospital
- Listed as
- St Joseph Health System, LLC
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Hospital certification: CCN 150047
- Legal name
- ST JOSEPH HEALTH SYSTEM LLC
- Doing business as
- LUTHERAN DOWNTOWN HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Mar 5, 2005
- Beds
- 191 (170 certified)
- Ownership / control type
- Private (for profit)
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 16, 1998 in DE
- Enrollment address
- 702 Van Buren St
Fort Wayne, IN 46802-3697 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin J Hammons |
Corporate Officer |
Feb 1, 2019 | |
| Corporate Director |
Jan 1, 2020 | ||
| Nathaniel K Summar |
Corporate Director |
Jul 15, 2017 | |
| Justin D Pitt |
Corporate Officer |
Mar 1, 2022 | |
| Corporate Director |
Mar 1, 2022 | ||
| Twilla Lee |
W-2 Managing Employee |
Jan 18, 2021 | |
| William Bradley Cash |
Corporate Officer |
Jun 1, 2018 | |
| Hma-Tri Holdings LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 100% |
| Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Jul 25, 2007 | 100% |
| Jason Kevin Johnson |
Corporate Officer |
Jan 6, 2020 | |
| Roman Gabriel Ottinger |
Corporate Officer |
Jan 6, 2020 | |
| DHFW Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jul 25, 2007 | 5.8% |
| Paula M Lalor |
Corporate Director |
Apr 1, 2017 | |
| Triad Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 100% |
| Tennyson Holdings LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2006 | 100% |
| Lutheran Health Network Investors LLC |
5% Or Greater Direct Ownership Interest | Jul 25, 2007 | 100% |
| Edna S Buffington-Price |
Corporate Director |
Mar 1, 2022 | |
| QHG of Fort Wayne Company LLC |
5% Or Greater Indirect Ownership Interest | Nov 30, 2014 | 42.45% |
| Lutheran Health Network of Indiana LLC |
5% Or Greater Indirect Ownership Interest | Nov 30, 2014 | 38.05% |
| Christopher G Cobb |
Corporate Officer |
Apr 1, 2017 | |
| CHS Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Jul 25, 2007 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040108000777 | IN | Part a Provider - Hospital | 5698686491 | Practice locations: Fort Wayne, IN |
National Provider Directory
Locations
1042 E Chapman Ave
Orange, CA 92866
Phone (714) 602-9224
702 Van Buren St
Fort Wayne, IN 46802
Phone (260) 425-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 05-005043-1 | IN | Yes |
Addresses
Primary practice location
702 Van Buren St
Fort Wayne, IN 46802-3697
Mailing address
15819 Collection Center Dr
Chicago, IL 60693-0158
Phone (260) 425-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100268500A | Medicaid | IN |
Other names
- Lutheran Downtown Hospital
Other providers in Fort Wayne, IN
- St Joseph Health System LLC
- St Joseph Health System LLC
- St Joseph Health System LLC
- St Joseph Medical Group Inc
- St. Joseph Health System LLC
- St. Joseph Health System, LLC
- St. Joseph Township EMS
- St. Vincent Hospital and Health Care Center, Inc.
- Jeff S Stachera
- Brent A Stachler
All providers in Fort Wayne, IN · General Acute Care Hospital in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2021. 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.