Sullivan County Community Hospital
Organization Active NPI Clinic/Center · Terre Haute, IN
NPI 1366076564 · NPPES record last updated Jan 30, 2026
Key facts
- NPI
- 1366076564
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- SULLIVAN COUNTY COMMUNITY HOSPITAL
- Practice address
- 4146 S 7TH St Ste B
Terre Haute, IN 47802-4123 - Phone
- (812) 281-2243
- NPI assigned
- Feb 26, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- SULLIVAN COUNTY COMMUNITY HOSPITAL
Authorized official
- Name
- Jennifer Ridgway
- Title
- Revenue Cycle Director
- Phone
- (812) 268-4311
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 6
Practitioners 44
-
Paul Matt Boland, FNP-C
-
Robert Ealy, APRN
-
Kayla Marie Kellams, MSN,FNP-C
-
Amy Nicole Sparks, FNP-C
-
Shahid Bashir, M.D.
-
Carl F. Conwell, MD
-
Dustin Clay Ellis, M.D.
-
Destiny Nicole Goldner, MS, LMHC-A
-
Spencer Greenwood, CRNA
-
Jennifer Ashley Gooch Holmes, FNP-C
-
Brigh Lachele Klitz, LMHC
-
Dane Michael Lee, CRNA
-
Jeanna Rennee Lisman, APN
-
Kathleen Pirtle, FNP
-
Kacey Dawn Poe, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Sullivan County Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1966 |
| Family Practice Associates of Sullivan County |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200414001364 | IN | Part B Supplier - Clinic/Group Practice | 2466497482 |
Receives reassigned benefits from 7 practitioners Practice locations: Dugger, IN; Terre Haute, IN |
National Provider Directory
- Tax ID family
- Sullivan County Community Hospital
- Part of
- Sullivan County Community Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
4146 S 7TH St Ste B
Terre Haute, IN 47802-4123
Mailing address
PO Box 10
Sullivan, IN 47882-0010
Phone (812) 268-4311
Other practice location 1
1005 S 3rd St
Dugger, IN 47848-5011
Phone (812) 648-0228
Other names
- Dugger Medical Clinic
- Sullivan Pain Management Center
Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2026. 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.