NPIMap

Organization Active NPI

Deaconess Memorial Medical Center Inc

  • Family Medicine Physician
  • Jasper, IN
National Provider Identifier
1104452200
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DEACONESS MEMORIAL MEDICAL CENTER INC
Practice address
695 W 2ND St Ste D
Jasper, IN 47546-3240
Phone
(812) 996-6330
Fax
(812) 996-6331
NPI assigned
Mar 20, 2020
Organization subpart
Yes
Parent organization
DEACONESS MEMORIAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Authorized official

Name
Keith Miller
Title
Cao & Indiana Region President
Phone
(812) 996-0507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

695 W 2ND St Ste D
Jasper, IN 47546-3240

Mailing address

800 W 9TH St
Jasper, IN 47546-2514
Phone (812) 996-8478

Other names 1

  • Alternative Screening Site Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000733 IN Part B Supplier - Clinic/Group Practice 4587578042 Receives reassigned benefits from 170 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, IN; Shoals, IN; Loogootee, IN; Montgomery, IN; Petersburg, IN; Santa Claus, IN; Washington, IN; Dale, IN…

Other NPIs on the same Medicare enrollment 36

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

View all 36

National Provider Directory

National Provider Directory
Part of
Little Company Hosp in Inc

Locations

695 2nd St
Ste D
Jasper, IN 47546
Phone (812) 996-0682

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1584662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1104452200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W 9TH ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475462514",
            "telephone_number": "812-996-8478",
            "fax_number": "812-996-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 W 2ND ST STE D",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475463240",
            "telephone_number": "812-996-6330",
            "fax_number": "812-996-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS MEMORIAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEACONESS MEMORIAL MEDICAL CENTER INC",
        "enumeration_date": "2020-03-20",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CAO & INDIANA REGION PRESIDENT",
        "authorized_official_telephone_number": "812-996-0507"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alternative Screening Site",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alternative Screening Site",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jasper, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; 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.