Active NPI
Deaconess Clinic, Inc
Doing business as Deaconess Clinic I
- Family Medicine Physician
- Evansville, IN
National Provider Identifier
1114173499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- DEACONESS CLINIC, INC
- Doing business as
- Deaconess Clinic I
- Practice address
- 350 W Columbia St
Ste 440
Evansville, IN 47710-1782 - Phone
- (812) 425-2461
- Fax
- (812) 424-7254
- NPI assigned
- Aug 18, 2008
- Last updated
- Nov 4, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Richard M Stivers
- Title
- Cfo
- Phone
- (812) 450-3296
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NU | Primary |
Addresses
Primary practice location
350 W Columbia St
Ste 440
Evansville, IN 47710-1782
Mailing address
PO Box 1510
Evansville, IN 47706-1510
Phone (812) 450-6815
Other names 1
- Deaconess Clinic I
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080922000145 | IN | Part B Supplier - Clinic/Group Practice | 3375610116 |
Receives reassigned benefits from 477 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219017600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1225756800000",
"number": "1114173499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1510",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477061510",
"telephone_number": "812-450-6815",
"fax_number": "812-450-6822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 W COLUMBIA ST",
"address_2": "STE 440",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477101782",
"telephone_number": "812-425-2461",
"fax_number": "812-424-7254"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DEACONESS CLINIC, INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-08-18",
"last_updated": "2008-11-04",
"status": "A",
"authorized_official_last_name": "STIVERS",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "812-450-3296"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Deaconess Clinic I",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Evansville, IN
- Deaconess Clinic, Inc (Deaconess Clinic I)
- Deaconess Clinic, Inc (Deaconess Comp Center)
- Deaconess Clinic, Inc (Deaconess Clinic II)
- Deaconess Clinic, Inc (Deaconess Clinic I)
- Deaconess Clinic, Inc (Deaconess Clinic I)
- Deaconess Clinic, Inc (Deaconess Clinic Sleep - East)
- Deaconess Clinic, Inc (Deaconess Clinic Sleep)
- Deaconess Clinic, Inc (Deaconess Clinic I)
- Deaconess Clinic, Inc (Deaconess Clinic I)
- Deaconess Clinic, Inc (Deaconess Clinic Sleep - IDTF)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; 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.