NPIMap

Good Samaritan Family Health Center, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Loogootee, IN

NPI 1124736715 · NPPES record last updated Sep 23, 2025

Key facts

NPI
1124736715
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Practice address
200 S John F Kennedy Ave
Loogootee, IN 47553-1624
Phone
(812) 295-3090
Fax
(812) 295-4328
NPI assigned
Nov 11, 2022
Organization subpart
Yes
Parent organization (as reported)
-

Authorized official

Name
Jennifer Emmons
Title
Ceo
Phone
(812) 494-7800

Other NPIs on the same Medicare enrollment 8

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

Corporate family (same tax ID) 29

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

View all 29

Practitioners 24

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IN

Federally qualified health center certification: CCN 151193

Legal name
GOOD SAMARITAN FAMILY HEALTH CENTER INC
Doing business as
MARTIN COUNTY FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 30, 2023
Last certification
May 30, 2023
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 25, 2017 in IN
Enrollment address
200 S John F Kennedy Ave
Loogootee, IN 47553-1624

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Stanley Graber
Individual 		Corporate Officer
Cfo		 May 17, 2023
Bridgett Bilskie
Individual 		W-2 Managing Employee
Payor Contract Manager		 May 17, 2023
Jennifer Emmons
Individual 		5% Or Greater Direct Ownership Interest
Ceo		 May 17, 2023 100%
Libby Gartner
Individual 		Corporate Director
Board Vice Chairman		 Oct 1, 2019
Philip Mangin
Individual 		Corporate Director
Board Chairman		 Oct 1, 2019
Traci French
Individual 		Corporate Director
Chief Exec Officer Is, Quality, Rev		 May 17, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190219002426 IN Part B Supplier - Clinic/Group Practice 5294099321 Receives reassigned benefits from 59 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Loogootee, IN; Washington, IN; Vincennes, IN; Petersburg, IN
O20230602000443 IN Part a Provider - Federally Qualified Health Center (FQHC) 5294099321 Practice locations: Loogootee, IN

National Provider Directory

Tax ID family
Good Samaritan Family Health Center Inc (30 organizations share this tax ID)
Part of
Good Samaritan Family Health Center Inc

Locations

215 E 4th St
Fl 1
Bicknell, IN 47512
Phone (812) 885-2720

1810 E State Road 56
Fl 1
Petersburg, IN 47567

2134 Washington Ave
Fl 3
Vincennes, IN 47591
Phone (812) 885-2720

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

200 S John F Kennedy Ave
Loogootee, IN 47553-1624

Mailing address

PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501

Other names

  • Family Health Center Doing business as

Other providers in Loogootee, IN

All providers in Loogootee, IN · Federally Qualified Health Center (FQHC) in Indiana

Sources for this page

Verify at the official NPI Registry.