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Decatur County Memorial Hospital

Organization Active NPI Rural Health Clinic/Center · Greensburg, IN

NPI 1295732188 · NPPES record last updated Mar 12, 2024

Key facts

NPI
1295732188
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
DECATUR COUNTY MEMORIAL HOSPITAL
Practice address
718 N. Lincoln St
Greensburg, IN 47240-1348
Phone
(812) 662-0588
Fax
(812) 663-5932
NPI assigned
Jul 7, 2005
Organization subpart
No

Authorized official

Name
Rex McKinney
Title
President//Ceo
Phone
(812) 663-4331

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 19

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 4

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

Practitioners 128

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 128

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN

Rural health clinic certification: CCN 158521

Legal name
DECATUR COUNTY MEMORIAL HOSPITAL
Doing business as
DECATUR COUNTY PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 4, 2017
Last certification
May 4, 2017
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Feb 5, 1987 in IN
Enrollment address
718 N Lincoln Street
Greensburg, IN 47240-1348
Related CCNs
151332

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Nicole S Boersma
Individual 		Corporate Director
Chief of Staff		 Jan 1, 2018 11%
Rex McKinney
Individual 		Corporate Director
President Ceo		 May 23, 2017 100%
W-2 Managing Employee
President Ceo		 May 23, 2017 100%
Operational/Managerial Control
President Ceo		 May 23, 2017 100%
Catherine Keck
Individual 		Corporate Director
Cfo		 Aug 1, 2017 100%
W-2 Managing Employee
Cfo		 Aug 1, 2017 100%
Jami B Rayles
Individual 		Corporate Director
Board Member		 Jan 1, 2022 11%
Malcomb Myers
Individual 		Corporate Director
Board Member		 Jan 1, 2022 11%
Patricia Cruser
Individual 		Corporate Director
Board Member		 Jan 1, 2018 11%
Tammy Williams
Individual 		Corporate Director
Board Member		 Jan 1, 2022 11%
Bryan Robbins
Individual 		Corporate Director
Board Member		 Jan 1, 2018 11%
Decatur County Memorial Hospital
Organization · Greensburg, IN
Corporation 		Operational/Managerial Control Mar 1, 2011 100%
Larry Rueff
Individual 		Corporate Director
Board Chairman		 Jan 1, 2022 11%
Mollie Fry
Individual 		Corporate Director
Board Member		 Jan 1, 2018 11%
Stephen Stringer
Individual 		Corporate Director
Board Vice Chair Member		 Mar 1, 2014 11%

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Morning Breeze Retirement Community and Healthcare Center
Greensburg, IN · CCN 155675		 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
Auburn, IN · CCN 155666		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
The Restoracy of Whitestown
Whitestown, IN · CCN 155858		 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
Greensburg, IN · CCN 158522		 Rural health clinic Operational/Managerial Control Mar 1, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20151202000485 IN Part a Provider - Rural Health Clinic 7315837671 Practice locations: Greensburg, IN

National Provider Directory

Tax ID family
Decatur County Mem Hosp (20 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

718 N. Lincoln St
Greensburg, IN 47240-1348

Mailing address

720 N. Lincoln St
Greensburg, IN 47240-1398
Phone (812) 663-4331

Other names

  • Decatur County Primary Care Doing business as

Other providers in Greensburg, IN

All providers in Greensburg, IN · Rural Health Clinic/Center in Indiana

Sources for this page

Verify at the official NPI Registry.