Decatur County Memorial Hospital
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Greensburg, IN
NPI 1285831396 · NPPES record last updated May 1, 2017
Key facts
- NPI
- 1285831396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 07-004714-1 (IN)
- Legal business name
- DECATUR COUNTY MEMORIAL HOSPITAL
- Practice address
- 720 N Lincoln St
Greensburg, IN 47240-1327 - Phone
- (812) 663-4331
- Fax
- (812) 663-9738
- NPI assigned
- Jul 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Michael Ruckel
- Title
- VP of Finance
- Phone
- (812) 663-4331
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 19
Related certifications (CCN) 1
Practitioners 128
-
Shakeeb Syed Ahmad, M.D.
-
Arthur P Alunday, MD
-
Anwar Chucky Ashraf, M.D.
-
Kenaz Bakdash, MD
-
Marcella Dawn Baumer, PA-C
-
James J Blahunka, MD
-
James R Bognanno, M.D.
-
Michael Boulous, MD
-
Justin P. Chang, M.D.
-
Jason Wayne Christie, M.D.
-
Jamie L Cooper, DO
-
Matthew T Dewitt, DPM
-
Erin Elizabeth Diem, FNP
-
Timothy D Divens, MD
-
Naveed A Fazlani, M.D., MBA
-
Michael D Fisher, MD
-
Jennifer L. Fletcher, M.D.
-
Luke Flood, MD
Affiliated clinicians 2
-
Jennifer L. Fletcher, M.D.
-
Maher K Ahmad, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Hospital certification: CCN 15Z332
- Legal name
- DECATUR COUNTY MEMORIAL HOSPITAL
- Doing business as
- DECATUR COUNTY MEMORIAL HOSPITAL
- Organization structure
- Government · Non-profit
- Enrollment address
- 720 N Lincoln St
Greensburg, IN 47240-1327
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Rex McKinney |
Corporate Officer |
May 23, 2017 | 100% |
| W-2 Managing Employee |
May 23, 2017 | 100% | |
| Operational/Managerial Control |
May 23, 2017 | 100% | |
| Catherine Keck |
Corporate Officer |
Aug 1, 2017 | 100% |
| W-2 Managing Employee |
Aug 1, 2017 | 100% | |
| Operational/Managerial Control |
Aug 1, 2017 | 100% | |
| Jennifer Simon |
Corporate Officer |
Jan 1, 2025 | 100% |
| W-2 Managing Employee |
Jan 1, 2025 | 100% | |
| Operational/Managerial Control |
Jan 1, 2025 | 100% |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Morning Breeze Retirement Community and Healthcare Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Apr 15, 2015 Apr 15, 2015 Apr 15, 2015 |
| Auburn Village |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2019 |
| The Restoracy of Whitestown |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
May 1, 2020 Jul 1, 2020 Jul 1, 2020 |
| Tree City Medical Partners |
Rural health clinic | Operational/Managerial Control | Mar 1, 2011 |
| Decatur County Primary Care |
Rural health clinic | Operational/Managerial Control (100%) | Mar 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071110000052 | IN | Part a Provider - Critical Access Hospital | 7315837671 | Practice locations: Greensburg, IN |
National Provider Directory
- Tax ID family
- Decatur County Mem Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 07-004714-1 | IN | Yes |
Addresses
Primary practice location
720 N Lincoln St
Greensburg, IN 47240-1327
Mailing address
720 N Lincoln St
Greensburg, IN 47240-1327
Phone (812) 663-4331
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100268720A | Medicaid | IN |
Other names
- Decatur County Memorial Hospital Swing Bed
Other providers in Greensburg, IN
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
- Decatur County Memorial Hospital
All providers in Greensburg, IN · Medicare Defined Swing Bed Hospital Unit in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2017. 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.