NPIMap

Organization Active NPI

Deaconess Clinic, Inc

Doing business as Deaconess Clinic II

  • Hematology & Oncology Physician
  • Newburgh, IN
National Provider Identifier
1356577985
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
DEACONESS CLINIC, INC
Doing business as
Deaconess Clinic II
Practice address
4055 Gateway Blvd
Newburgh, IN 47630-8947
Phone
(812) 842-3051
Fax
(812) 858-3060
NPI assigned
Jun 10, 2009
Last updated
Jun 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Authorized official

Name
Cheryl A Wathen
Title
Cfo
Phone
(812) 450-3296

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Acute Care Nurse Practitioner 363LA2100X NU
Clinical Nurse Specialist 364S00000X NU
Hematology (Internal Medicine) Physician 207RH0000X NU
Hematology & Oncology Physician 207RH0003X NU Primary
Urology Physician 208800000X NU

Addresses

Primary practice location

4055 Gateway Blvd
Newburgh, IN 47630-8947

Mailing address

PO Box 3868
Evansville, IN 47737-3868
Phone (812) 858-3051

Other names 1

  • Deaconess Clinic II Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080922000145 IN Part B Supplier - Clinic/Group Practice 3375610116 Receives reassigned benefits from 477 practitioners
This NPI is an additional NPI on the enrollment
O20081017000259 KY Part B Supplier - Clinic/Group Practice 3375610116 Receives reassigned benefits from 190 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sebree, KY; Philpot, KY; Owensboro, KY; Morganfield, KY; Madisonville, KY; Henderson, KY; Dixon, KY

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory

Locations

3355 Liberty Blvd
Boonville, IN 47601
Phone (812) 858-3355

120 SE 4th St
#120
Evansville, IN 47708

15814 Neeley St
Evansville, IN 47725
Phone (812) 867-8991

350 W Columbia St
Ste 200
Evansville, IN 47710
Phone (812) 425-2646

8600 University Blvd
Evansville, IN 47712
Phone (812) 461-5446

7878 S Professional Dr
Fort Branch, IN 47648

4015 Gateway Blvd
Newburgh, IN 47630
Phone (812) 858-6244

4015 Gateway Blvd
Ste 3000
Newburgh, IN 47630

4111 Gateway Blvd
Newburgh, IN 47630
Phone (812) 853-5300

4209 Gateway Blvd
#D
Newburgh, IN 47630

4233 Gateway Blvd
#1
Newburgh, IN 47630
Phone (812) 477-1560

4233 Gateway Blvd
Bldg 1
Newburgh, IN 47630

4233 Gateway Blvd
Ste 220
Newburgh, IN 47630

1808 Sherman Dr
Ste 2208
Princeton, IN 47670

312 3rd Ave
Princeton, IN 47670
Phone (812) 386-6775

1305 N Elm St
Ste G
Henderson, KY 42420
Phone (270) 826-0002

6071 Highway 54
Philpot, KY 42366
Phone (270) 685-9499

3315 Burke Rd
Ste 306
Pasadena, TX 77504
Phone (281) 768-1247

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1356577985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3868",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477373868",
            "telephone_number": "812-858-3051",
            "fax_number": "812-426-9503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308947",
            "telephone_number": "812-842-3051",
            "fax_number": "812-858-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Clinic II",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deaconess Clinic II",
            "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 Jun 3, 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.