NPIMap

Deaconess Speciality Physicians, Inc

Organization Active NPI Endocrinology, Diabetes & Metabolism Physician · Henderson, KY

NPI 1124787973 · NPPES record last updated Dec 9, 2021

Key facts

NPI
1124787973
Entity type
Organization (NPI type 2)
Primary specialty
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Legal business name
DEACONESS SPECIALITY PHYSICIANS, INC
Practice address
1413 N Elm St Ste 106
Henderson, KY 42420-2776
Phone
(270) 831-7937
Fax
(270) 831-7939
NPI assigned
Dec 9, 2021
Organization subpart
No

Authorized official

Name
Cheryl Annette Wathen
Title
Cfo
Phone
(812) 450-3296

Other NPIs on the same Medicare enrollment 12

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

Corporate family (same tax ID) 40

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

View all 40

Practitioners 3

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

  • Sarah A Koehler, AGPNP Adult Health Nurse Practitioner · Princeton, IN · NPI 1124728050
    NPD NURSE PRACTITIONER
  • Jill Spencer Miller, APRN Nurse Practitioner · Evansville, IN · NPI 1952650749
    NPD NURSE PRACTITIONER
  • Ibrahim Selevany, M.D. Clinical Cardiac Electrophysiology Physician · San Diego, CA · NPI 1992239206
    NPD

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180608001730 KY Part B Supplier - Clinic/Group Practice 0244595205 Receives reassigned benefits from 80 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henderson, KY; Owensboro, KY; Morganfield, KY

National Provider Directory

Tax ID family
Deaconess Specialty Physicians Inc (41 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RE0101X Yes
Medical Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363AM0700X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

1413 N Elm St Ste 106
Henderson, KY 42420-2776

Mailing address

PO Box 1230
Evansville, IN 47706-1230
Phone (812) 450-6815

Other providers in Henderson, KY

All providers in Henderson, KY · Endocrinology, Diabetes & Metabolism Physician in Kentucky

Sources for this page

Verify at the official NPI Registry.