NPIMap

Organization Active NPI

Good Samaritan Hospital

Doing business as Center for Therapy and Sports Performance

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Vincennes, IN
National Provider Identifier
1073153474
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
GOOD SAMARITAN HOSPITAL
Doing business as
Center for Therapy and Sports Performance
Practice address
2020 S Clearview Dr
Vincennes, IN 47591-5576
Phone
(812) 885-3011
Fax
(812) 885-3217
NPI assigned
Jan 14, 2020
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SAMARITAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Robert McLin
Title
Ceo
Phone
(812) 882-5220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X NU Primary

Addresses

Primary practice location

2020 S Clearview Dr
Vincennes, IN 47591-5576

Mailing address

1160 E Saint Clair St
Vincennes, IN 47591-4853
Phone (812) 885-3453

Other names 1

  • Center for Therapy and Sports Performance Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000723 IN Part B Supplier - Clinic/Group Practice 9436061918 Receives reassigned benefits from 12 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vincennes, IN
O20071116000420 IN Part A Provider - Hospital 9436061918 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monroe City, IN; Vincennes, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073153474. Details of each certification follow.

Hospital certification: CCN 150042

Legal name
GOOD SAMARITAN HOSPITAL
Doing business as
GOOD SAMARITAN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 8, 2016
Beds
165
Ownership / control type
Other
Organization structure
OtherNon-profit
Enrollment address
520 South Seventh St
Vincennes, IN 47591-1038
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Good Samaritan HospitalCCN 150042 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Samaritan Center

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Adam L Thacker Individual Corporate OfficerCeo Jan 6, 2026
Operational/Managerial ControlCeo Jan 6, 2026
Matthew Schuckman Individual Corporate OfficerCfo Dec 29, 2013
Operational/Managerial ControlCfo Dec 29, 2013
Stanley Dewesse Individual Corporate OfficerSecretary Feb 1, 2022
Kellie Streeter Individual Corporate OfficerBoard Member Feb 1, 2022
Susan Brocksmith Individual Corporate OfficerChairman Feb 1, 2022
Good Samaritan Hospital Organization, Vincennes, IN Non-profit Other Apr 5, 2015
Thomas Joseph Brink Individual Corporate OfficerBoard Member Feb 1, 2022

Owners & managing parties with NPI records 25

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

View all 25

Practitioners & affiliated clinicians

Affiliated clinicians 469

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 469

NPI Registry JSON

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1073153474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 E SAINT CLAIR ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914853",
            "telephone_number": "812-885-3453",
            "fax_number": "812-885-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 S CLEARVIEW DR",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475915576",
            "telephone_number": "812-885-3011",
            "fax_number": "812-885-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN HOSPITAL",
        "enumeration_date": "2020-01-14",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "MCLIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-882-5220"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Therapy and Sports Performance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Center for Therapy and Sports Performance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.