NPIMap

Organization Active NPI

St. Mary's Warrick Hospital, Inc.

Doing business as Ascension St. Vincent Warrick

  • Medicare Defined Swing Bed Hospital Unit
  • Boonville, IN
National Provider Identifier
1073668273
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
ST. MARY'S WARRICK HOSPITAL, INC.
Doing business as
Ascension St. Vincent Warrick
St. Vincent Warrick
Practice address
1116 Millis Avenue
Boonville, IN 47601
Phone
(812) 897-4800
Fax
(812) 897-7375
NPI assigned
Jan 25, 2007
Last updated
Jun 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Authorized official

Name
Marty P. Mattingly
Title
Administrator
Phone
(812) 897-7112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

1116 Millis Avenue
Boonville, IN 47601

Mailing address

1116 Millis Ave
Boonville, IN 47601-2204
Phone (812) 897-4800

Other identifiers 5

IdentifierTypeStateIssuer
000000054341OtherINANTHEM BLUE CROSS
100270700MedicaidIN
032184200OtherFEDERAL BLACK LUNG
1341114MedicaidKY
I013944OtherCHAMPUS

Other names 2

  • Ascension St. Vincent Warrick Doing business as
  • St. Vincent Warrick Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220525001187 IN Part A Provider - Critical Access Hospital 5799722591 Practice locations: Boonville, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073668273. Details of each certification follow.

Hospital certification: CCN 15Z325

Legal name
ST MARYS WARRICK HOSPITAL INC
Doing business as
ASCENSION ST. VINCENT WARRICK
Organization structure
CorporationNon-profit
Enrollment address
1116 Millis Ave
Boonville, IN 47601-2204
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Johnathan Pope Individual Corporate DirectorBoard Member Jul 1, 2021
Ernest L Johnson Individual Corporate DirectorBoard Member Mar 1, 2018
Marty Mattingly Individual Corporate OfficerAdministrator May 31, 2019
W-2 Managing EmployeeAdministrator May 31, 2019
Operational/Managerial ControlAdministrator May 31, 2019
Jonathan S Nalli Individual Operational/Managerial ControlHome Office-President & Ceo Mar 1, 2018 100%
Tricia M Hollander-Henning Individual Corporate DirectorBoard Member Jul 1, 2021
Michael a Herrell Individual Corporate DirectorBoard Member Jul 31, 2013
James Sandgren Individual Corporate DirectorBoard Member Jul 1, 2020
Todd D Renschler Individual Corporate DirectorBoard Member Jul 1, 2021
Brian Schymik Individual Corporate DirectorBoard Member Mar 1, 2019
Rita P Eykamp Individual Corporate DirectorBoard Member Mar 1, 2018
Chrstine Fredric Individual Corporate DirectorBoard Member May 31, 2019
St Vincent Health Inc Organization, Indianapolis, IN Corporation 5% Or Greater Direct Ownership Interest Oct 1, 2014 100%
Operational/Managerial Control Oct 1, 2014 100%
Kevin Valadares Individual Corporate DirectorBoard Member Jul 1, 2021
Sally G Rideout Individual Corporate DirectorBoard Member Jul 31, 2013

Owners & managing parties with NPI records 2

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

Facilities with the same owner 29

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

View all 29

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1073668273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 MILLIS AVE",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "476012204",
            "telephone_number": "812-897-4800",
            "fax_number": "812-897-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 MILLIS AVENUE",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "47601",
            "telephone_number": "812-897-4800",
            "fax_number": "812-897-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S WARRICK HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "MARTY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "812-897-7112"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000054341",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270700",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "032184200",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1341114",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "I013944",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent Warrick",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Vincent Warrick",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boonville, IN

Sources for this page

Verify at the official NPI Registry.