Organization Active NPI

Deaconess Women's Hospital of Southern Indiana, LLC

Doing business as The Women's Hospital Provider Services

Gynecologic Oncology Physician
Newburgh, IN

National Provider Identifier

1114297801

Registry record updated Jul 8, 2022

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Newburgh, IN
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License: 130028551 Issued in IN
Legal business name: DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Doing business as: The Women's Hospital Provider Services
Practice address: 4199 Gateway Blvd
Newburgh, IN 47630-8940
Phone: (812) 842-4200
Fax: (812) 842-4227
NPI assigned: Jan 11, 2012
Last updated: Jul 8, 2022By the provider in NPPES
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Authorized official

Name: Christina Ryan
Title: Chief Executive Officer
Phone: (812) 842-4222

Specialties & licenses 15

Specialty (taxonomy)	Code	License	State	Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP	1041C0700X
Genetic Counselor (M.S.)Group: 193200000X MULTI-SPECIALTY GROUP	170300000X	74000008A	IN
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207V00000X	130028551	IN
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207VF0040X
Gynecologic Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	207VX0201X	130028551	IN	Primary
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP	208200000X	01067142A	IN
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP	225100000X	05002666A	IN
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP	363A00000X	140028551	IN
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363L00000X	130028551	IN
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LF0000X
Neonatal Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LN0000X
Critical Care Neonatal Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LN0005X
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LW0102X
Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP	364S00000X

Addresses

Primary practice location

4199 Gateway Blvd
Newburgh, IN 47630-8940

Mailing address

4199 Gateway Blvd
Newburgh, IN 47630-8940
Phone (812) 842-4200

Other identifiers 16

Identifier	Type	State
200871730	Medicaid	IN
201046630A	Medicaid	IN
201380400	Medicaid	IN
201003930	Medicaid	IN
201044710	Medicaid	IN
201046630B	Medicaid	IN
200931070	Medicaid	IN
200934360	Medicaid	IN
200950810	Medicaid	IN
201386290A	Medicaid	IN
100319460	Medicaid	IN
201003570	Medicaid	IN
201118520	Medicaid	IN
200245730	Medicaid	IN
200951280	Medicaid	IN
201395600A	Medicaid	IN

Other names 1

The Women's Hospital Provider Services Doing business as

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in IN

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20050325000731	IN	Part B Supplier - Clinic/Group Practice	4183699432	Receives reassigned benefits from 53 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Evansville, IN; Newburgh, IN

Other NPIs on the same Medicare enrollment 4

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

Deaconess Women's Hospital of Southern Indiana, LLC

dba The Women's Hospital
- General Acute Care Hospital
- Newburgh, IN
- NPI 1114023512
O20050325000731
Same enrollment
Deaconess Women's Hospital of Southern Indiana, LLC

dba Anesthesia Services at The Women's Hospital
- Anesthesiology Physician
- Newburgh, IN
- NPI 1245272921
O20050325000731
Same enrollment
Deaconess Women's Hospital of Southern Indiana, LLC

dba Tri State Perinatology at the Women's Hospital
- Maternal & Fetal Medicine Physician
- Newburgh, IN
- NPI 1306011796
O20050325000731
Same enrollment
Deaconess Women's Hospital of Southern Indiana, LLC
- Non-Surgical Family Planning Clinic/Center
- Evansville, IN
- NPI 1609689561
O20050325000731
Same enrollment

National Provider Directory

Locations

4199 Gateway Blvd
Ste 3100
Newburgh, IN 47630
Phone (812) 842-4550

Practitioners & affiliated clinicians

Practitioners 32

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.

Preston Jerome Edge, MD
- Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
- Newburgh, IN
- NPI 1023544475
NPD
Emily K Ernst, ARNP
- Nurse Practitioner
- Indianapolis, IN
- NPI 1174000178
NPD
Wayne L Farley Jr., DO
- Obstetrics & Gynecology Physician
- Paoli, IN
- NPI 1093764417
NPD
Dominique L Gariti, MD
- Obstetrics Physician
- Newburgh, IN
- NPI 1083671663
Obstetrics & Gynecology
NPD
Guido Peter Gutter, M.D.
- Plastic Surgery Physician
- Evansville, IN
- NPI 1982703740
NPD
Maria C. Herron, MD
- Obstetrics & Gynecology Physician
- Newburgh, IN
- NPI 1831189919
NPD
Elizabeth Johnson
- Family Nurse Practitioner
- Evansville, IN
- NPI 1871600247
NPD
Katie M Lawless, APRN
- Family Nurse Practitioner
- Newburgh, IN
- NPI 1770031098
NPD
Erika N McCombs, PT
- Physical Therapist
- Newburgh, IN
- NPI 1780845081
NPD
Amy L McLurkin, PT
- Physical Therapist
- Newburgh, IN
- NPI 1831263961
NPD
Dimple Amin Royalty, M.D.
- Anesthesiology Physician
- Evansville, IN
- NPI 1336343417
NPD
Kelsey Sammet
- Nurse Practitioner
- Newburgh, IN
- NPI 1306518634
NPD

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1114297801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4199 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308940",
            "telephone_number": "812-842-4200",
            "fax_number": "812-842-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308940",
            "telephone_number": "812-842-4200",
            "fax_number": "812-842-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "812-842-4222"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "170300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
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            "license": "74000008A",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
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            "primary": false
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        {
            "code": "207VF0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
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            "state": null,
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            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
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            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "IN",
            "license": "01067142A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05002666A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
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            "primary": false
        },
        {
            "code": "363L00000X",
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            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Neonatal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
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            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
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            "license": null,
            "primary": false
        }
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    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Women's Hospital Provider Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Women's Hospital Provider Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newburgh, IN

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; 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.