NPIMap

Organization Active NPI

Pulaski Memorial Hospital

Doing business as Majestic Care of Bedford

  • Skilled Nursing Facility
  • Bedford, IN
National Provider Identifier
1104831718
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PULASKI MEMORIAL HOSPITAL
Doing business as
Majestic Care of Bedford
Practice address
2111 Norton LN.
Bedford, IN 47421-4522
Phone
(812) 277-3730
Fax
(812) 279-9550
NPI assigned
Jul 30, 2006
Last updated
May 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Authorized official

Name
Gregg A Malott
Title
Chief Financial Officer
Phone
(574) 946-2103

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X NU
Custodial Care Facility 311Z00000X NU
Nursing Facility/Intermediate Care Facility 313M00000X NU
Skilled Nursing Facility 314000000X NU Primary
Pediatric Skilled Nursing Facility 3140N1450X NU

Addresses

Primary practice location

2111 Norton LN.
Bedford, IN 47421-4522

Mailing address

2111 Norton LN.
Bedford, IN 47421-4522
Phone (812) 277-3730

Other identifiers 4

IdentifierTypeStateIssuer
100450900AMedicaidIN
100274460BMedicaidIN
100274460MedicaidIN
000000098145OtherINANTHEM BLUE CROSS

Other names 1

  • Majestic Care of Bedford Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130204000101 IN Part A Provider - Skilled Nursing Facility 7214916113 Practice locations: Bedford, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104831718. Details of each certification follow.

Skilled nursing facility certification: CCN 155100

Legal name
COLUMBUS REGIONAL HOSPITAL
Doing business as
MAJESTIC CARE OF BEDFORD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 25, 1969
Last certification
Mar 28, 2025
Beds
142
Ownership / control type
Corporation
Multi-facility organization
Majestic Care
Organization structure
GovernmentNon-profit
Enrollment address
2111 Norton LN
Bedford, IN 47421-4522

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Majestic Care of BedfordCCN 155100 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 25, 1969
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
142101.1 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0698183Pulaski Memorial Hospital2111 Norton LN, Bedford, IN 47421Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Columbus Reg Hosp-Psy a5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2111 Norton Ln
Bedford, IN 47421
Phone (812) 277-3730

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
David Alexander Individual Operational/Managerial Control May 1, 2023
Organization, Lakewood, NJ LLC Adp of the SNF Jun 26, 2025
Frederick G Shedd Individual Managing Control - Governing BodyBoard Member Jan 3, 2012
Organization, Flushing, NY LLC Adp of the SNF May 1, 2023
David Doup Individual Managing Control - Governing BodyBoard Member Jan 4, 2016
Alberta Taybior Individual Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023
Individual Adp of the SNF Sep 11, 2023
Don Trapp Individual Managing Control - Governing BodyBoard Member Aug 28, 2017
Individual Adp of the SNF May 1, 2023
Angela Rewa Individual Operational/Managerial Control Oct 23, 2023
Adp of the SNF Oct 23, 2023
Annette Jobe Individual Operational/Managerial Control Sep 11, 2025
Robert Laron Russell Individual Operational/Managerial Control Apr 8, 2024
Adp of the SNF Apr 8, 2024
Kevina Schumaker Individual Managing Control - Governing BodyBoard Member Jan 1, 2022
Organization, Flushing, NY LLC Adp of the SNF May 1, 2023
Majestic Care of BB Consulting LLC Organization, Flushing, NY LLC Operational/Managerial Control May 1, 2023
Adp of the SNF May 21, 2025
Paul Pruitt Individual Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023
Donald L Michael Individual Managing Control - Governing BodyBoard Member Jan 5, 2009
Organization, Flushing, NY LLC Adp of the SNF Jun 23, 2025
Kevin D Neese Individual Operational/Managerial Control May 1, 2023
Adp of the SNF May 1, 2023
Raymond Lee Kiser Individual Operational/Managerial Control Apr 1, 2025
Columbus Regional Hospital Organization, Columbus, IN Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
Zack Ellison Individual Managing Control - Governing BodyBoard Member Jan 2, 2013
Anzhelika Shatrov Individual Operational/Managerial Control Dec 2, 2024
Adp of the SNF Dec 2, 2024
James D Bickel Individual Operational/Managerial Control Aug 15, 2025
Majestic Care of Bedford, LLC Organization, Flushing, NY LLC Operational/Managerial Control May 1, 2023
Adp of the SNF Jun 20, 2025
Eric Wolfe Individual Operational/Managerial Control Sep 11, 2023
Individual Adp of the SNF May 1, 2023

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Columbus Regional HospitalColumbus, IN, CCN 150112 Hospital Operational/Managerial Control (100%) Mar 7, 2013
Majestic Care of BloomingtonBloomington, IN, CCN 155019 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2012
The Belmont Health & RehabilitationColumbus, IN, CCN 155133 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 6

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.

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": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778457600000",
    "number": "1104831718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 NORTON LN.",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474214522",
            "telephone_number": "812-277-3730",
            "fax_number": "812-279-9550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 NORTON LN.",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474214522",
            "telephone_number": "812-277-3730",
            "fax_number": "812-279-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A",
        "authorized_official_last_name": "MALOTT",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "574-946-2103"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100450900A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274460B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274460",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000098145",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Majestic Care of Bedford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bedford, IN

Sources for this page

Verify at the official NPI Registry.