Johnson Memorial Hospital

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

06-000049-1 Issued in IN

Legal business name

JOHNSON MEMORIAL HOSPITAL

Doing business as

The Waters of LaGrange Skilled Nursing Facility

Practice address

787 N Detroit St
Lagrange, IN 46761-1111

Phone

(574) 466-2172

Fax

(574) 463-2180

NPI assigned

Jul 22, 2006

Last updated

Jan 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Dunkle, MD

Title

President/Ceo

Phone

(317) 736-3396

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• The Waters of LaGrange Skilled Nursing Facility Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255352399. Details of each certification follow.

• CCN 155118 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 155118

Legal name

JOHNSON MEMORIAL HOSPITAL

Doing business as

THE WATERS OF LAGRANGE SKILLED NURSING FACILITY

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Aug 11, 1970

Last certification

Oct 1, 2024

Beds

100

Ownership / control type

Corporation

Organization structure

GovernmentNon-profit

Enrollment address

787 N Detroit St
Lagrange, IN 46761-1111

Nursing home name

WATERS OF LAGRANGE SKILLED NURSING FACILITY, THE

Affiliated entity

INFINITY HEALTHCARE CONSULTING

Listed as

Waters of Lagrange Skilled Nursing Facility, theCCN 155118 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

1 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Aug 11, 1970

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10083.5 residents per day on average

Chain

Infinity Healthcare Consulting69 facilities in the chain

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Johnson Memorial Immedi37 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.

• Johnson Memorial Hospital

  dba The Waters of Sullivan Skilled Nursing Facility

  • Skilled Nursing Facility
  • Sullivan, IN
  • NPI 1003838194
  NPD tax ID
• Johnson Memorial Hospital

  dba The Waters of Syracuse Skilled Nursing Facility

  • Skilled Nursing Facility
  • Syracuse, IN
  • NPI 1023031465
  NPD tax ID
• Johnson Memorial Hospital

  dba The Waters of Fort Wayne Skilled Nursing Facility

  • Skilled Nursing Facility
  • Fort Wayne, IN
  • NPI 1033132477
  NPD tax ID
• Johnson Memorial Hospital

  dba Compass Park

  • Skilled Nursing Facility
  • Franklin, IN
  • NPI 1053301259
  NPD tax ID
• Johnson Memorial Hospital

  dba The Waters of Castleton Skilled Nursing Facility

  • Skilled Nursing Facility
  • Indianapolis, IN
  • NPI 1114940558
  NPD tax ID
• Johnson Memorial Hospital

  dba Miller's Merry Manor

  • Skilled Nursing Facility
  • Warsaw, IN
  • NPI 1114947686
  NPD tax ID
• Johnson Memorial Hospital

  dba The Waters of Rushville Skilled Nursing Facility

  • Skilled Nursing Facility
  • Rushville, IN
  • NPI 1134142573
  NPD tax ID
• Johnson Memorial Hospital

  dba The Waters of Wabash Skilled Nursing Facility West

  • Skilled Nursing Facility
  • Wabash, IN
  • NPI 1144236415
  NPD tax ID
• Johnson Memorial Hospital

  dba Miller's at Oak Pointe

  • Skilled Nursing Facility
  • Columbia City, IN
  • NPI 1144627977
  NPD tax ID
• Johnson Memorial Hospital

  dba Miller's Merry Manor

  • Skilled Nursing Facility
  • Hope, IN
  • NPI 1194747287
  NPD tax ID
• Johnson Memorial Hospital

  dba Millers Merry Manor

  • Skilled Nursing Facility
  • Marion, IN
  • NPI 1215111067
  NPD tax ID
• Johnson Memorial Hospital

  dba The Waters of Wabash Skilled Nursing Facility East

  • Skilled Nursing Facility
  • Wabash, IN
  • NPI 1235150376
  NPD tax ID

All disclosed owners & managing parties 9

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

Owners & managing parties with NPI records 1

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

• David H Dunkle, MD

  • Family Medicine Physician
  • Franklin, IN
  • NPI 1053468041

  Corporate Director, Corporate Officer, Operational/Managerial Control

  CMS ownership

All facility ownership & control disclosures 34

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

Facilities with the same owner 34

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

• Johnson Memorial Hospital

  dba The Waters of Sullivan Skilled Nursing Facility

  • Skilled Nursing Facility
  • Sullivan, IN
  • NPI 1003838194

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership
• Johnson Memorial Hospital

  dba The Waters of Syracuse Skilled Nursing Facility

  • Skilled Nursing Facility
  • Syracuse, IN
  • NPI 1023031465

  Johnson Memorial Hospital

  CMS ownership
• Johnson Memorial Hospital

  dba The Waters of Fort Wayne Skilled Nursing Facility

  • Skilled Nursing Facility
  • Fort Wayne, IN
  • NPI 1033132477

  Johnson Memorial Hospital

  CMS ownership
• Johnson Memorial Hospital

  dba Compass Park

  • Skilled Nursing Facility
  • Franklin, IN
  • NPI 1053301259

  Johnson Memorial Hospital

  CMS ownership
• Johnson Memorial Hospital

  dba The Waters of Castleton Skilled Nursing Facility

  • Skilled Nursing Facility
  • Indianapolis, IN
  • NPI 1114940558

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership
• Johnson Memorial Hospital

  dba Miller's Merry Manor

  • Skilled Nursing Facility
  • Warsaw, IN
  • NPI 1114947686

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership
• Johnson Memorial Hospital

  dba The Waters of Rushville Skilled Nursing Facility

  • Skilled Nursing Facility
  • Rushville, IN
  • NPI 1134142573

  Johnson Memorial Hospital

  CMS ownership
• Johnson Memorial Hospital

  dba The Waters of Wabash Skilled Nursing Facility West

  • Skilled Nursing Facility
  • Wabash, IN
  • NPI 1144236415

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership
• Johnson Memorial Hospital

  dba Miller's at Oak Pointe

  • Skilled Nursing Facility
  • Columbia City, IN
  • NPI 1144627977

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership
• Johnson Memorial Hospital

  dba Miller's Merry Manor

  • Skilled Nursing Facility
  • Hope, IN
  • NPI 1194747287

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership
• Johnson Memorial Hospital

  dba Millers Merry Manor

  • Skilled Nursing Facility
  • Marion, IN
  • NPI 1215111067

  Johnson Memorial Hospital

  CMS ownership
• Johnson Memorial Hospital

  dba The Waters of Wabash Skilled Nursing Facility East

  • Skilled Nursing Facility
  • Wabash, IN
  • NPI 1235150376

  Johnson Memorial Hospital, Miller's Health Systems Inc

  CMS ownership

Affiliated clinicians 1

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

• Paul Traianos Kaplanis, M.D.

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1497860167

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1255352399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 W JEFFERSON ST",
            "city": "FRANKLIN",
            "state": "IN",
            "postal_code": "461312140",
            "telephone_number": "317-736-3396",
            "fax_number": "317-736-2692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "787 N DETROIT ST",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467611111",
            "telephone_number": "574-466-2172",
            "fax_number": "574-463-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "DUNKLE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "317-736-3396",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "06-000049-1",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "IN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270890A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "aputvin@johnsonmemorial.org",
            "affiliation": "N",
            "address_1": "787 N Detroit St",
            "city": "LaGrange",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467611111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Waters of LaGrange Skilled Nursing Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hook-Superx LLC (CVS Pharmacy #06501)
• Richard B Hostetter, M.D.
• Hasan Ilyas, MD
• Krista Jackson, PA
• Timothy A Jessie, MD
• Nicole Johnson-Smith
• McKenna Lorraine Juday, FNP
• Vijay G.T. Kamineni, M.D.
• Rebecca L Kaminski, D.O.
• Shashank Nmi Kashyap, M.D.

• Skilled Nursing Facility in Lagrange, IN
• Providers in Lagrange, IN by specialty
• Skilled Nursing Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.