NPIMap

Organization Active NPI

State of Indiana - Auditor of State

Doing business as Richmond State Hospital

  • Psychiatric Hospital
  • Richmond, IN
National Provider Identifier
1093933236
Registry record updated May 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF INDIANA - AUDITOR OF STATE
Doing business as
Richmond State Hospital
Practice address
498 NW 18TH St
Richmond, IN 47374-2851
Phone
(765) 966-0511
Fax
(765) 935-9503
NPI assigned
Apr 23, 2007
Last updated
May 5, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
INDIANA STATE FAMILY & SOCIAL SERVICE ADMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2014

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

Authorized official

Name
David M Shelford
Title
Assistant Superintendent
Phone
(765) 935-9206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NU Primary

Addresses

Primary practice location

498 NW 18TH St
Richmond, IN 47374-2851

Mailing address

498 NW 18TH St
Richmond, IN 47374-2851
Phone (765) 966-0511

Other identifiers 1

IdentifierTypeStateIssuer
100256720AMedicaidIN

Other names 1

  • RICHMOND STATE HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000564 IN Part B Supplier - Clinic/Group Practice 1759280118 Receives reassigned benefits from 113 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evansville, IN; Indianapolis, IN; Logansport, IN; Madison, IN; Richmond, IN; West Lafayette, IN

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
State of Indiana Auditor of State32 organizations share this tax ID, including this one
Part of
State of Indiana Auditor of State

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

498 NW 18th St
Richmond, IN 47374
Phone (765) 966-0511

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399248000000",
    "number": "1093933236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 NW 18TH ST",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473742851",
            "telephone_number": "765-966-0511",
            "fax_number": "765-935-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "498 NW 18TH ST",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473742851",
            "telephone_number": "765-966-0511",
            "fax_number": "765-935-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF INDIANA - AUDITOR OF STATE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIANA STATE FAMILY & SOCIAL SERVICE ADM",
        "enumeration_date": "2007-04-23",
        "last_updated": "2014-05-05",
        "status": "A",
        "authorized_official_last_name": "SHELFORD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ASSISTANT SUPERINTENDENT",
        "authorized_official_telephone_number": "765-935-9206"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100256720A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RICHMOND STATE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.