Witham Memorial Hospital

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WITHAM MEMORIAL HOSPITAL

Practice address

2605 N Lebanon St
Lebanon, IN 46052-1476

Phone

(765) 485-8000

NPI assigned

Jan 29, 2007

Organization subpart

No

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

• Witham Memorial Hospital

  • Clinical Medical Laboratory
  • Lebanon, IN
  • NPI 1558493767

  O20040519001402

  Same enrollment
• Witham Memorial Hospital

  • Physical Therapist
  • Zionsville, IN
  • NPI 1952282204

  O20040519001402

  Same enrollment
• Witham Memorial Hospital

  • Physical Therapist
  • Frankfort, IN
  • NPI 1992276745

  O20040519001402

  Same enrollment

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert B Arthur, MD

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1376531798

  Family Medicine, IN

  Medicare reassignment NPD
• Dawn M Ayers, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Zionsville, IN
  • NPI 1306823513

  IN

  Medicare reassignment NPD
• Casey Ann Bagwell, NP

  • Family Nurse Practitioner
  • Indianapolis, IN
  • NPI 1770216756

  IN

  Medicare reassignment NPD
• Mirza M Baig, M.D, FACP

  • Nephrology Physician
  • Greenfield, IN
  • NPI 1134371487

  IN

  Medicare reassignment NPD
• Kara Dian Bell, NP

  • Hospitalist Physician
  • Lebanon, IN
  • NPI 1679510440

  IN

  Medicare reassignment NPD
• Jessica Marie Bingham, FNP - C

  • Family Nurse Practitioner
  • Lebanon, IN
  • NPI 1427617810

  IN

  Medicare reassignment NPD
• Douglas Blacklidge, DPM

  • Foot & Ankle Surgery Podiatrist
  • Kokomo, IN
  • NPI 1003901133

  IN

  Medicare reassignment NPD
• Matthew Thomas Bobzien IV, MD

  • Family Medicine Physician
  • Jamestown, IN
  • NPI 1962508812

  Family Medicine, IN

  Medicare reassignment NPD
• Kevin Boone, NP

  • Nurse Practitioner
  • Lebanon, IN
  • NPI 1376869669

  IN

  Medicare reassignment NPD
• James Anthony Boudreau, MD

  • Family Medicine Physician
  • Lebanon, IN
  • NPI 1215923941

  Family Medicine, IN

  Medicare reassignment NPD
• Benjamin Brewster, MD

  • Surgery Physician
  • Lebanon, IN
  • NPI 1316100423

  IN

  Medicare reassignment NPD
• Brian W Buoscio, MD

  • Internal Medicine Physician
  • Lebanon, IN
  • NPI 1912994534

  IN

  Medicare reassignment NPD

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

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

Locations

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

Authorized official

Name

Kelly Braverman

Title

Ceo, President

Phone

(765) 485-8100

Specialties & licenses 1

Addresses

Other names 1

• Witham Health Services Doing business as

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1083750293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476",
            "telephone_number": "765-485-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A",
        "authorized_official_last_name": "BRAVERMAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO, PRESIDENT",
        "authorized_official_telephone_number": "765-485-8100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Witham Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Neal Williams, LCSW
• Abraham Wilson, RBT
• Craig Jeffrey Wilson, MD
• Si-Ron M Wilson, PTA
• Ted R Winkler, MD
• Witham Memorial Hospital
• Witham Memorial Hospital
• Witham Memorial Hospital
• Witham Memorial Hospital
• Witham Memorial Hospital

• All providers in Lebanon, IN
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.