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Organization Active NPI

Decatur County Memorial Hospital

Doing business as Decatur County Memorial Hospital Retail Pharmacy

  • Community/Retail Pharmacy
  • Greensburg, IN
National Provider Identifier
1316307184
Registry record updated Apr 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60006562A Issued in IN
Legal business name
DECATUR COUNTY MEMORIAL HOSPITAL
Doing business as
Decatur County Memorial Hospital Retail Pharmacy
Practice address
720 N Lincoln St
Greensburg, IN 47240-1327
Phone
(812) 663-1250
Fax
(812) 663-1190
NPI assigned
Mar 7, 2016
Last updated
Apr 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2016

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

Authorized official

Name
Linda Simmons
Title
President/Ceo
Phone
(812) 663-1170

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 60006562A IN Primary

Addresses

Primary practice location

720 N Lincoln St
Greensburg, IN 47240-1327

Mailing address

720 N Lincoln St
Greensburg, IN 47240-1327
Phone (812) 663-1250

Other identifiers 2

IdentifierTypeStateIssuer
100268720AMedicaidIN
2158498OtherPK

Other names 1

  • Decatur County Memorial Hospital Retail Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160517002425 IN Part B Supplier - Mass Immunization (Roster Biller Only) 7315837671 Practice locations: Greensburg, IN

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Decatur County Mem Hosp20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Morning Breeze Retirement Community and Healthcare CenterGreensburg, 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 VillageAuburn, IN, CCN 155666 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
The Restoracy of WhitestownWhitestown, 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 PartnersGreensburg, IN, CCN 158522 Rural health clinic Operational/Managerial Control Mar 1, 2011
Decatur County Primary CareGreensburg, IN, CCN 158521 Rural health clinic Operational/Managerial Control (100%) Mar 1, 2011

Owned or controlled facilities with NPI records 5

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

NPI Registry JSON

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

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461715200000",
    "number": "1316307184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N LINCOLN ST",
            "city": "GREENSBURG",
            "state": "IN",
            "postal_code": "472401327",
            "telephone_number": "812-663-1250",
            "fax_number": "812-663-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N LINCOLN ST",
            "city": "GREENSBURG",
            "state": "IN",
            "postal_code": "472401327",
            "telephone_number": "812-663-1250",
            "fax_number": "812-663-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-07",
        "last_updated": "2016-04-27",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "812-663-1170"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006562A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100268720A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158498",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Decatur County Memorial Hospital Retail Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensburg, IN

Sources for this page

Verify at the official NPI Registry.