Woodlawn Hospital
Organization Active NPI Skilled Nursing Facility · South Bend, IN
NPI 1184604233 · NPPES record last updated Feb 15, 2016
Key facts
- NPI
- 1184604233
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 050026621 (IN)
- Legal business name
- WOODLAWN HOSPITAL
- Practice address
- 6450 Miami Cir
South Bend, IN 46614-6480 - Phone
- (574) 231-1000
- Fax
- (574) 231-5566
- NPI assigned
- Jan 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. John Alley
- Title
- President/Ceo
- Phone
- (574) 223-3141
Owners & managing parties with NPI records 16
Owned or controlled facilities with NPI records 15
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 25
Facilities with the same owner 15
Practitioners 30
-
James Timothy Aldridge, D.O.
-
Omazonna Amadi, MD
-
Leigh Barts, FNP-C
-
Joseph Peter Binfet, M.D.
-
Michael J Brubaker, D.O.
-
Keri Rae Federspiel, FNP
-
Jerrod A Feldman, MD
-
Kelly Ann Friar, PA-C
-
Shannon Michelle Guckien, FNP-BC
-
Monzur Haque, M.D.
-
Kelsey Heckaman, FNP
-
Jennifer Hensley, FNP
-
Gina L Moore, FNP
-
Janell Nicole Mulligan, FNP-C
-
John E Nile, D.O.
-
Kevin O'Brien, MD
-
Teresa Marie Perkins, APRN, BC
-
Eric Rindlisbacher, DPM
-
Elizabeth Rodriguez, FNP-BC
-
Debra F Sanders, MD
-
Brigitte R Selio, MD
Affiliated clinicians 2
-
Jerome Rusceak Skelly, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Southfield Village
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - County
- Certified
- Dec 28, 2000
- Medicare certification status
- Active
- Certified beds
- 60 · 52.7 residents per day on average
- Chain
- Greencroft Communities
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0978286 | Southfield Village | Certificate of waiver | Sep 19, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Skilled nursing facility certification: CCN 155684
- Legal name
- WOODLAWN HOSPITAL
- Doing business as
- SOUTHFIELD VILLAGE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Dec 28, 2000
- Last certification
- Oct 31, 2024
- Beds
- 138 (60 certified)
- Ownership / control type
- County
- Multi-facility organization
- Woodlawn Hospital
- Organization structure
- Other · Non-profit
- Enrollment address
- 6450 Miami Cir
South Bend, IN 46614-6480 - Nursing home name
- SOUTHFIELD VILLAGE
- Affiliated entity
- GREENCROFT COMMUNITIES
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Alison M Heyde |
Corporate Director |
Sep 9, 2019 | |
| Operational/Managerial Control | Nov 1, 2025 | ||
| Alan Jay Fisher |
Corporate Officer |
Jun 13, 2022 | |
| Joseph M Doran |
5% Or Greater Direct Ownership Interest | Nov 1, 2025 | |
| Terri L Johnson |
Corporate Director |
Jun 13, 2022 | |
| Travis P Albright |
Corporate Director |
Jun 13, 2022 | |
| Nancy J Day |
Corporate Director |
Nov 1, 2015 | |
| Woodlawn Hospital |
5% Or Greater Direct Ownership Interest | Nov 1, 2015 | 100% |
| Southfield Village Inc |
Operational/Managerial Control | Nov 1, 2015 | |
| Steven D Furnivall |
Corporate Director |
Nov 1, 2015 | |
| Gregory Lee Mellinger |
Corporate Director |
Jun 13, 2022 |
All facility ownership & control disclosures 15
| Facility | Type | Role | Since |
|---|---|---|---|
| Woodlawn Hospital |
Hospital | Operational/Managerial Control | Jan 8, 2010 |
| Woodlawn Hospital |
Hospital | Operational/Managerial Control | Jan 8, 2010 |
| Grace Village Health Care Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
May 1, 2013 May 28, 2025 |
| Wesley Manor Health Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Apr 8, 2013 Mar 12, 2025 |
| Timbercrest Church of the Brethren Home |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2014 |
| Peabody Retirement Community |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Oct 31, 2014 Dec 17, 2025 |
| Greencroft Healthcare |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2015 |
| Hamilton Grove |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Nov 1, 2015 Dec 8, 2025 |
| Oak Grove Christian Retirement Village |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) 5% Or Greater Indirect Ownership Interest (100%) Adp of the SNF |
Jan 1, 2016 Jan 1, 2016 Nov 17, 2025 |
| Golden Years Homestead |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Woodlawn Medical Professionals |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2012 Aug 1, 2013 |
| Argos Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2012 Aug 1, 2013 |
| Akron Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2012 Aug 1, 2013 |
| Shafer Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2012 Jan 1, 2012 |
| Fulton County Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2012 Aug 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151222002109 | IN | Part a Provider - Skilled Nursing Facility | 4082506993 | Practice locations: South Bend, IN |
National Provider Directory
- Tax ID family
- Akron Medical
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 050026621 | IN | Yes |
Addresses
Primary practice location
6450 Miami Cir
South Bend, IN 46614-6480
Mailing address
6450 Miami Cir
South Bend, IN 46614-6480
Phone (574) 231-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000192793 | Other | IN | ANTHEM BLUE CROSS BLUE SH |
| 200315930A | Medicaid | IN |
Other providers in South Bend, IN
- Amy Wolschlager
- Lacy Marie Wolter
- Marcia Louise Wong
- Steven C Wong
- Mary Robin Wood
- Sarah Anne Woodrick
- Woodrige Alf Operations LLC
- Hannah Woodruff
- John Robert Woods
- Donna Lynn Woodward
All providers in South Bend, 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 Feb 15, 2016. 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.