Good Samaritan Family Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Elnora, IN
NPI 1275423758 · NPPES record last updated Jul 7, 2025
Key facts
- NPI
- 1275423758
- 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
- 5494 E State Road 58
Elnora, IN 47529-5063 - Phone
- (812) 494-9514
- Fax
- (812) 494-9515
- NPI assigned
- Jul 7, 2025
- Organization subpart
- Yes
- Parent organization (as reported)
- GOOD SAMARITAN FAMILY HEALTH CENTER
Authorized official
- Name
- Jennifer Emmons
- Title
- Ceo
- Phone
- (812) 494-9501
Corporate family (same tax ID) 29
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Federally qualified health center certification: CCN C51109
- Legal name
- GOOD SAMARITAN FAMILY HEALTH CENTER INC
- Doing business as
- FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 2025
- Last certification
- Oct 1, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 5494 E State Road 58
FL 1
Elnora, IN 47529-5063
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Stanley Graber |
Corporate Officer |
Dec 1, 2022 | |
| Bridgett Bilskie |
W-2 Managing Employee |
Jul 28, 2021 | |
| Joseph Williams |
Other |
Sep 1, 2022 | |
| Stormey Wiegman |
W-2 Managing Employee |
Apr 15, 2024 | |
| Kolby Kerzan |
Other |
Sep 1, 2022 | |
| Jennifer Emmons |
5% Or Greater Direct Ownership Interest |
Sep 25, 2017 | 100% |
| Traci French |
Corporate Officer |
May 17, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251015003446 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 5294099321 | Practice locations: Elnora, IN |
National Provider Directory
- Tax ID family
- Good Samaritan Family Health Center Inc
- Part of
- Good Samaritan Family Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
5494 E State Road 58
Elnora, IN 47529-5063
Mailing address
PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501
Other names
- Family Health Center
Other providers in Elnora, IN
All providers in Elnora, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.