Johnson Memorial Hospital
Organization Active NPI Skilled Nursing Facility · Indianapolis, IN
NPI 1114940558 · NPPES record last updated Jan 30, 2023
Key facts
- NPI
- 1114940558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 05-000171-2 (IN)
- Legal business name
- JOHNSON MEMORIAL HOSPITAL
- Practice address
- 8400 Clearvista PL
Indianapolis, IN 46256-3700 - Phone
- (317) 845-0464
- Fax
- (317) 841-4183
- NPI assigned
- Jul 26, 2006
- Organization subpart
- No
Authorized official
- Name
- David Dunkle, MD
- Title
- President/Ceo
- Phone
- (317) 736-3396
Owners & managing parties with NPI records 1
-
David H Dunkle, MD
Corporate family (same tax ID) 36
Facilities with the same owner 34
Affiliated clinicians 1
-
Saif M Choudhury, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Waters of Castleton Skilled Nursing Facility, the
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 12, 1985
- Medicare certification status
- Active
- Certified beds
- 114 · 51.6 residents per day on average
- Chain
- Infinity Healthcare Consulting
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Skilled nursing facility certification: CCN 155271
- Legal name
- JOHNSON MEMORIAL HOSPITAL
- Doing business as
- THE WATERS OF CASTLETON SKILLED NURSING FACILITY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Nov 12, 1985
- Last certification
- Oct 8, 2024
- Beds
- 114
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- Government · Non-profit
- Enrollment address
- 8400 Clearvista PL
Indianapolis, IN 46256-3700 - Nursing home name
- WATERS OF CASTLETON SKILLED NURSING FACILITY, THE
- Affiliated entity
- INFINITY HEALTHCARE CONSULTING
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| David H Dunkle |
Corporate Officer | Mar 1, 2019 | |
| Corporate Director | Mar 1, 2019 | ||
| Operational/Managerial Control | Mar 1, 2019 | ||
| Miller'S Health Systems Inc |
Operational/Managerial Control | Mar 1, 2013 | |
| Jance Peterson |
Contracted Managing Employee |
Jul 1, 2016 | |
| Steven Berkhouse |
Corporate Officer |
Oct 18, 2021 | |
| Corporate Director |
Oct 18, 2021 | ||
| The Waters of Castleton Skilled Nursing Facility LLC |
Operational/Managerial Control | Nov 1, 2022 | 100% |
| Johnson Memorial Hospital |
5% Or Greater Direct Ownership Interest | Mar 1, 2013 | 100% |
| Robert J Decola |
W-2 Managing Employee |
Feb 16, 2019 | |
| Patrick H Boyle |
Other | May 30, 2017 | |
| Lashelle Crawley |
Contracted Managing Employee |
Aug 9, 2022 | 100% |
All facility ownership & control disclosures 34
| Facility | Type | Role | Since |
|---|---|---|---|
| Millers Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jul 1, 2012 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jul 1, 2012 Jul 1, 2012 |
| The Waters of Lagrange Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Dunkirk Skilled Nursing Facilty |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Sullivan Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Rushville Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Syracuse Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Tipton Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Peru Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Rockport Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Chesterfield Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Fort Wayne Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Wakarusa Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Hartford City Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Columbia City Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Middletown Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Huntington Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Hobart Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2023 |
| Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Millers at Oak Pointe |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2014 |
| The Waters of Wabash Skilled Nursing Facility East |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| The Waters of Wabash Skilled Nursing Facility West |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| Millers Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Oct 1, 2015 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Greenwood Village South |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Nov 1, 2016 Nov 1, 2016 Jul 9, 2025 |
| Miller'S Health & Rehab by Miller'S Merry Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Compass Park |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jan 1, 2023 Jan 1, 2023 Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130529000611 | IN | Part a Provider - Skilled Nursing Facility | 8527972595 | Practice locations: Indianapolis, IN |
National Provider Directory
- Tax ID family
- Emergency Medical Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | |||
| Skilled Nursing Facility | 314000000X | 05-000171-2 | IN | Yes |
| Nursing Facility Supplies (DME) | 332BN1400X | |||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | IN |
Addresses
Primary practice location
8400 Clearvista PL
Indianapolis, IN 46256-3700
Mailing address
1125 W Jefferson St
Franklin, IN 46131-2140
Phone (317) 736-3396
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100267050A | Medicaid | IN |
Other names
- The Waters of Castleton Skilled Nursing Facility
Other providers in Indianapolis, IN
- Shelley A Johns
- Susan Ann Johns
- Susan Louise Johns X
- Alicia Marie Johnson Bryant
- Johnson Family Dentistry LLC
- Johnson Memorial Hospital
- Lindsay R Johnson-Heck
- Janet Elaine Johnson-Leclair
- Tina Johnson-McCrackin
- A'Mya Johnson
All providers in Indianapolis, IN · Skilled Nursing Facility in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.