NPIMap

Organization Active NPI

Deaconess Women's Hospital of Southern Indiana, LLC

Doing business as Tri State Perinatology at the Women's Hospital

  • Maternal & Fetal Medicine Physician
  • Newburgh, IN
National Provider Identifier
1306011796
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
Legal business name
DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Doing business as
Tri State Perinatology at the Women's Hospital
Practice address
4199 Gateway Blvd Ste 3100
Newburgh, IN 47630-7906
Phone
(812) 842-4550
Fax
(812) 842-4549
NPI assigned
Apr 25, 2008
Last updated
May 29, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2020

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

Authorized official

Name
Christina M Ryan
Title
Ceo
Phone
(812) 842-4200

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Perinatal Clinical Nurse Specialist 364SP1700X
Maternal & Fetal Medicine Physician 207VM0101X Primary
Genetic Counselor (M.S.) 170300000X

Addresses

Primary practice location

4199 Gateway Blvd Ste 3100
Newburgh, IN 47630-7906

Mailing address

PO Box 637273
Cincinnati, OH 45263-7273
Phone (812) 842-4260

Other identifiers 1

IdentifierTypeStateIssuer
200921280AMedicaidIN

Other names 1

  • TRI STATE PERINATOLOGY AT THE WOMEN'S HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050325000731 IN Part B Supplier - Clinic/Group Practice 4183699432 Receives reassigned benefits from 53 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evansville, IN; Newburgh, IN

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Women's Hospital of Southern Indiana9 organizations share this tax ID, including this one
Part of
Deaconess Women's Hospital of Southern Indiana

Other organizations with this tax ID 8

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1306011796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 637273",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452637273",
            "telephone_number": "812-842-4260",
            "fax_number": "812-602-3174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 GATEWAY BLVD STE 3100",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476307906",
            "telephone_number": "812-842-4550",
            "fax_number": "812-842-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN, LLC",
        "enumeration_date": "2008-04-25",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-842-4200"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP1700X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Perinatal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200921280A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRI STATE PERINATOLOGY AT THE WOMEN'S HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newburgh, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.