NPIMap

Organization Active NPI

Witham Memorial Hospital

Doing business as Wellbrooke of Carmel

  • Skilled Nursing Facility
  • Carmel, IN
National Provider Identifier
1194115386
Registry record updated Mar 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WITHAM MEMORIAL HOSPITAL
Doing business as
Wellbrooke of Carmel
Practice address
12315 N Pennsylvania St
Carmel, IN 46032-6600
Phone
(317) 569-7200
Fax
(317) 569-7201
NPI assigned
Jan 27, 2015
Last updated
Mar 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2022

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

Authorized official

Name
Kelly Braverman
Title
Ceo, President
Phone
(765) 485-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

12315 N Pennsylvania St
Carmel, IN 46032-6600

Mailing address

PO Box 221648
Louisville, KY 40252-1648
Phone (502) 412-5847

Other identifiers 1

IdentifierTypeStateIssuer
201294880MedicaidIN

Other names 1

  • Wellbrooke of Carmel Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151021002400 IN Part A Provider - Skilled Nursing Facility 4082523170 Practice locations: Carmel, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194115386. Details of each certification follow.

Skilled nursing facility certification: CCN 155833

Legal name
WITHAM MEMORIAL HOSPITAL
Doing business as
WELLBROOKE OF CARMEL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 3, 2015
Last certification
Jan 17, 2025
Beds
119 (74 certified)
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Welltower
Organization structure
OtherNon-profit
Enrollment address
12315N Pennsylvania St
Carmel, IN 46032-6600
Nursing home name
WELLBROOKE OF CARMEL
Affiliated entity
TRILOGY HEALTH SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wellbrooke of CarmelCCN 155833 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 3, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7453.4 residents per day on average
Chain
Trilogy Health Services123 facilities in the chain
Penalties (3 years)
1Fines totaling $15,646

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2093910BD Trustees of Flavius J Witham Mem Hosp12315 N Pennsylvania St, Carmel, IN 46032Certificate of waiverApr 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
James Anthony Boudreau37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Member organizations 19

Organizations listed as members of this organization in the National Provider Directory.

View all 19

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Julie Reagan Individual Corporate DirectorBoard Trustee Sep 25, 2024
American Healthcare Reit Inc Organization, Irvine, CA Real estate investment trust (REIT) Adp of the SNF Oct 1, 2018
Kelly Braverman Individual Corporate OfficerCeo, President Dec 1, 2021 100%
Trilogy Real Estate Investment Trust Organization, Irvine, CA Real estate investment trust (REIT) Adp of the SNF Dec 1, 2015
Kylie Carmack Individual Operational/Managerial Control Mar 6, 2023
Adp of the SNF Jul 9, 2025
Trilogy Reit Holdings LLC Organization, Irvine, CA LLC Adp of the SNF Dec 1, 2015
Stephen J Bardoczi Individual Corporate OfficerVP of Senior Support Services Sep 3, 2013
Trilogy Management Services LLC Organization, Louisville, KY Management services company, Chain home office Adp of the SNF Oct 15, 2025
Gahc3 Trilogy JV LLC Organization, Irvine, CA LLC Adp of the SNF Dec 1, 2015
Witham Memorial Hospital Organization, Lebanon, IN 5% Or Greater Direct Ownership Interest Jul 1, 2015 100%
Daniel E Sellers Individual Corporate OfficerSVP-Cfo Jun 20, 2024
American Healthcare Reit Holdings LP Organization, Irvine, CA Holding company Adp of the SNF Dec 1, 2015
Michael Jason Hornbecker Individual Corporate DirectorBoard Trustee Jan 1, 2024
RHS Partners of Carmel LLC Organization, Carmel, IN LLC Operational/Managerial Control Jul 1, 2015
Andrea Castetter Individual Corporate DirectorBoard Trustee Jan 1, 2023
Claude a Hawkins Individual Corporate DirectorBoard Trustee Sep 9, 2013
John W Brand Individual Corporate DirectorBoard Trustee Jan 1, 2015
Saad a Hafidh Individual Operational/Managerial Control Jul 15, 2025
Adp of the SNF Jul 15, 2025
Paragon Outpatient Rehabilitation Services LLC Organization, Louisville, KY Medical provider/supplier Adp of the SNF Dec 1, 2015
Trilogy Investors LLC Organization, Louisville, KY LLC Adp of the SNF Dec 1, 2015
Trilogy Healthcare Holdings Inc Organization, Louisville, KY Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2015 100%
Trilogy Property Holdings LLC Organization, Louisville, KY LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 1, 2022 100%
Welltower Inc Organization, Toledo, OH Real estate investment trust (REIT) Adp of the SNF Dec 1, 2015
Brett Bayston Individual Corporate DirectorBoard Trustee Jan 1, 2023
Trilogy Propco Master Tenant III LLC Organization, Louisville, KY LLC Adp of the SNF Jul 9, 2025
Continental Merger Sub LLC Organization, Irvine, CA LLC Adp of the SNF Oct 1, 2021
Gahc4 Trilogy JV LLC Organization, Irvine, CA LLC Adp of the SNF Oct 1, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 31

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Witham Health ServicesLebanon, IN, CCN 150104 Hospital Operational/Managerial Control (100%) Nov 24, 2011
Ambassador HealthcareCenterville, IN, CCN 155490 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2011
Vermillion Convalescent CenterClinton, IN, CCN 155124 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Twin City HealthcareGas City, IN, CCN 155232 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Westridge Health Care CenterTerre Haute, IN, CCN 155234 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Persimmon Ridge Rehabilitation CentrePortland, IN, CCN 155526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Grand Valley Health & RehabMartinsville, IN, CCN 155605 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Willow Crossing Health & Rehabilitation CenterColumbus, IN, CCN 155535 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Pineknoll Rehabilitation CentreWinchester, IN, CCN 155527 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Camelot Care CenterLogansport, IN, CCN 155385 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2012
Alexandria Care CenterAlexandria, IN, CCN 155521 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2012
White Oak Health CampusMonticello, IN, CCN 155782 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
St Mary Healthcare CenterLafayette, IN, CCN 155094 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Waterford Place Health CampusKokomo, IN, CCN 155678 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Cumberland Pointe Health CampusWest Lafayette, IN, CCN 155775 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Blair Ridge Health CampusPeru, IN, CCN 155791 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Woodbridge Health CampusLogansport, IN, CCN 155724 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Greenleaf Health CampusElkhart, IN, CCN 155783 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
St Elizabeth Healthcare CenterDelphi, IN, CCN 155290 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Homewood Health CampusLebanon, IN, CCN 155680 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Arlington Place Health CampusIndianapolis, IN, CCN 155816 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Wellbrooke of WabashWabash, IN, CCN 155806 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Wellbrooke of KokomoKokomo, IN, CCN 155819 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
The Villages at Historic SilvercrestNew Albany, IN, CCN 155813 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
The Springs at LafayetteLafayette, IN, CCN 155829 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Clearvista Lake Health CampusIndianapolis, IN, CCN 155815 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
McGivney Health Care CenterCarmel, IN, CCN 155855 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015
Brooke Knoll VillageAvon, IN, CCN 155814 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
Westminster Village KentuckianaClarksville, IN, CCN 155191 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2023
Suburban Home Health, LLCNoblesville, IN, CCN 157092 Home health agency 5% Or Greater Indirect Ownership Interest (10.27%) Sep 3, 2024
Suburban HospiceNoblesville, IN, CCN 151547 Hospice 5% Or Greater Indirect Ownership Interest (10.27%) Nov 1, 2024

Facilities with the same owner 94

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 94

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648252800000",
    "number": "1194115386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221648",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402521648",
            "telephone_number": "502-412-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12315 N PENNSYLVANIA ST",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460326600",
            "telephone_number": "317-569-7200",
            "fax_number": "317-569-7201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2022-03-26",
        "certification_date": "2022-03-26",
        "status": "A",
        "authorized_official_last_name": "BRAVERMAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO, PRESIDENT",
        "authorized_official_telephone_number": "765-485-8100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201294880",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellbrooke of Carmel",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellbrooke of Carmel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.