Organization Active NPI

Lifespring Inc.

Doing business as Jasper Community Medical Services

  • Federally Qualified Health Center (FQHC)
  • Jasper, IN
National Provider Identifier
1023681889
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LIFESPRING INC.
Doing business as
Jasper Community Medical Services
Practice address
480 Eversman Dr
Jasper, IN 47546-3548
Phone
(812) 280-2080
NPI assigned
Jul 20, 2021
Last updated
Aug 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFESPRING INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Authorized official

Name
Dr. Beth Keeney, DRPH
Title
Evp Community Health
Phone
(812) 206-1362

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

480 Eversman Dr
Jasper, IN 47546-3548

Mailing address

460 Spring St
Jeffersonville, IN 47130-3452
Phone (812) 280-2080

Other names 1

  • Jasper Community Medical Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040315000128 IN Part B Supplier - Clinic/Group Practice 5294624508 Receives reassigned benefits from 66 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Albany, IN; Paoli, IN; Rockport, IN; Salem, IN; Scottsburg, IN; Tell City, IN; Jeffersonville, IN; Madison, IN…
O20040805000332 IN Part B Supplier - Clinic/Group Practice 5294624508 Receives reassigned benefits from 115 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dale, IN; Tell City, IN; Scottsburg, IN; Salem, IN; Rockport, IN; Paoli, IN; New Albany, IN; Madison, IN…
O20210830003089 IN Part A Provider - Federally Qualified Health Center (FQHC) 5294624508 Practice locations: Jasper, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023681889. Details of each certification follow.

Federally qualified health center certification: CCN 151115

Legal name
LIFESPRING, INC
Doing business as
JASPER COMMUNITY MEDICAL SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 25, 2021
Last certification
Aug 25, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
480 Eversman Dr
Jasper, IN 47546-3548

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2239806Jasper Community Medical Services480 Eversman Dr, Jasper, IN 47546Certificate of waiverOct 13, 2027

National Provider Directory

National Provider Directory
Part of
Lifespring Inc

Locations

2277 W Frontage Rd
Austin, IN 47102
Phone (812) 413-3117

523 N Main St
English, IN 47118
Phone (812) 338-2756

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tiffany Pollock Individual W-2 Managing EmployeeCredentialing Specialist Jun 1, 2024
Alan Smock Individual Corporate DirectorBoard Member Jan 1, 2022
Jacalyn Young Individual Corporate OfficerSecretary Jun 1, 2024
Emily Stumler Individual Corporate DirectorBoard Member Jan 1, 2022
Paul Kiger Individual Corporate OfficerMember Jun 1, 2024
Misty L Kannapel Gilbert Individual Corporate DirectorCoo Jun 1, 2024
Nick Clark Individual Corporate DirectorCfo Jun 1, 2024
Melissa Campbell Individual Corporate OfficerMember Jun 1, 2024
Darnell Jackson Individual Corporate OfficerChair Jun 1, 2024
Lifespring, Inc Organization, Jeffersonville, IN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2024 100%
Margo Olson Individual Corporate OfficerMember Jun 1, 2024
Anne Beth Kenney Individual Corporate OfficerAuthorized Official Jan 1, 2021
W-2 Managing EmployeeAuthorized Official Jan 1, 2021
Operational/Managerial ControlAuthorized Official Jan 1, 2021
OtherCeo Jan 1, 2021
Wendy Broughton Individual Corporate DirectorBoard Member Jan 1, 2022
Denise Eden Individual Corporate DirectorBoard Member Jan 1, 2022
Rossina Sandoval Monsivais Individual Corporate OfficerChair-Elect Jun 1, 2024
Kenny Kavanaugh Individual Corporate OfficerMember Jun 1, 2024
Kristie Swoboda Individual Corporate DirectorPractice Manager Director Jun 1, 2024
Ray Oppel Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 16

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 16

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lifespring Community Medical ServicesJeffersonville, IN, CCN 151959 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Salem Community Medical ServicesSalem, IN, CCN 151979 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 15, 2016
Lifespring Adult Integrated Medical ServicesJeffersonville, IN, CCN 151037 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2019
Lifespring, IncJeffersonville, IN, CCN 151058 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 15, 1966
Austin Medical CenterAustin, IN, CCN 151081 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 16, 1966
New Albany Student Health CenterNew Albany, IN, CCN 151113 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2024
Metro Mobile UnitNew Albany, IN, CCN 151156 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 16, 1966
Dale Community Medical ServicesDale, IN, CCN C51081 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2024
Lifespring Orleans Family HealthOrleans, IN, CCN C51090 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 24, 2024
Charlestown Community Medical ServicesCharlestown, IN, CCN C51088 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 21, 2024
Lifespring Forensics Health ServicesJeffersonville, IN, CCN C51089 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2024
Floyd Central Student Health CenterFloyds Knobs, IN, CCN C51107 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 27, 2023

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 12

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

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1023681889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 SPRING ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471303452",
            "telephone_number": "812-280-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 EVERSMAN DR",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475463548",
            "telephone_number": "812-280-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPRING INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFESPRING INC",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "KEENEY",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "EVP COMMUNITY HEALTH",
        "authorized_official_telephone_number": "812-206-1362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DRPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jasper Community Medical Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jasper, IN

Sources for this page

Verify at the official NPI Registry.