NPIMap

Organization Active NPI

St. Vincent Medical Group, Inc.

Doing business as Ascension Medical Group St. Vincent

  • Rural Health Clinic/Center
  • North Vernon, IN
National Provider Identifier
1376816975
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. VINCENT MEDICAL GROUP, INC.
Doing business as
Ascension Medical Group St. Vincent
Practice address
301 Henry St
North Vernon, IN 47265-1030
Phone
(812) 352-4300
NPI assigned
Feb 14, 2012
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Brian Morris
Title
Cfo
Phone
(317) 338-6234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

301 Henry St
North Vernon, IN 47265-1030

Mailing address

10330 N Meridian St
Suite 201
Indianapolis, IN 46290-1024

Other names 1

  • Ascension Medical Group St. Vincent Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100609000045 IN Part B Supplier - Clinic/Group Practice 7012047640 Receives reassigned benefits from 998 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20120815000376 IN Part A Provider - Rural Health Clinic 7012047640 Practice locations: North Vernon, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376816975. Details of each certification follow.

Rural health clinic certification: CCN 153887

Legal name
ST VINCENT MEDICAL GROUP INC
Doing business as
ASCENSION MEDICAL GROUP ST. VINCENT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2008
Last certification
Mar 3, 2020
Ownership / control type
1B
Most recent change of ownership
Jul 1, 2012 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Mar 4, 2010 in IN
Enrollment address
301 Henry Street
North Vernon, IN 47265-1030

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

301 Henry St
#F13
North Vernon, IN 47265

Ownership & related parties

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
Karl Wayne Sash Individual Corporate DirectorMD Jul 1, 2018
Karen C Wendowski Individual Corporate Director Jul 1, 2018
Gregory John Mazanek Individual Corporate Director Jul 1, 2012
Brandon Jeremy Perkins Individual Corporate DirectorDO Jul 1, 2018
Richard Ira Fogel Individual Corporate Officer Jul 1, 2012
Aaron G Shoemaker Individual Corporate DirectorMD, Cmo, Amg-in Jul 1, 2018
Bradley J McNabb Individual Corporate DirectorCoo Nov 19, 2013
W-2 Managing Employee Nov 19, 2013
Jennifer L Stanley Individual Corporate DirectorMD Jul 1, 2018
St Vincent Medical Group Inc Organization, Indianapolis, IN Non-profit Operational/Managerial Control Jul 1, 2012
Randy Joseph Irwin Individual Corporate DirectorMD Jul 1, 2018
Elizabeth Louise Helms Individual Corporate Director Jul 1, 2018
Mazen Alsatie Individual Corporate Director Jul 1, 2018

Owners & managing parties with NPI records 12

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Ascension Medical Group St. VincentWinchester, IN, CCN 153881 Rural health clinic Operational/Managerial Control Jul 1, 2012
Ascension Medical Group St. VincentUnion City, IN, CCN 153879 Rural health clinic Operational/Managerial Control Jul 1, 2012

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1376816975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 N MERIDIAN ST",
            "address_2": "SUITE 201",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HENRY ST",
            "city": "NORTH VERNON",
            "state": "IN",
            "postal_code": "472651030",
            "telephone_number": "812-352-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-14",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-338-6234"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Medical Group St. Vincent",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Vernon, IN

Sources for this page

Verify at the official NPI Registry.