Greene County Health, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Jasonville, IN
NPI 1386042653 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1386042653
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GREENE COUNTY HEALTH, INC
- Practice address
- 326 E Main St
Jasonville, IN 47438-1510 - Phone
- (812) 665-9000
- Fax
- (812) 665-9009
- NPI assigned
- Dec 18, 2014
- Organization subpart
- No
Authorized official
- Name
- Crystal Plano
- Title
- Cfo
- Phone
- (812) 699-4153
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 1
Facilities with the same owner 1
Practitioners 8
-
Jennifer Bell, FNP
-
Leslie B Copp, FNP-C
-
Derek Parkes, M.D.
-
Carolyn Suniga, LCSW
-
Ann Marie Vash, FNP
-
Lisa Bredeweg, NP
-
Billie Jo Fritch, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2063508 | Greene County Health Inc | Certificate of waiver | Aug 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Federally qualified health center certification: CCN 151986
- Legal name
- GREENE COUNTY HEALTH INC
- Doing business as
- GREENE COUNTY HEALTH SHAKAMAK
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 12, 2017
- Last certification
- Jul 12, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 27, 2015 in IN
- Enrollment address
- 326 E Main St
Jasonville, IN 47438-1510
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Dennis Green |
Corporate Officer |
Feb 1, 2017 | |
| Lianne E Wilson |
Corporate Officer |
Feb 1, 2015 | |
| Elizabeth M Burrows |
Corporate Officer |
Feb 1, 2015 | |
| Corporate Director |
Feb 1, 2015 | ||
| W-2 Managing Employee |
Feb 1, 2015 | ||
| Operational/Managerial Control |
Feb 1, 2015 | ||
| Sue Ann Johnson |
Corporate Officer |
Feb 1, 2017 | |
| Linda D Bedwell |
Corporate Officer |
Feb 1, 2015 | |
| Corporate Director |
Feb 1, 2015 | ||
| W-2 Managing Employee |
Feb 1, 2015 | ||
| Operational/Managerial Control |
Feb 1, 2015 | ||
| Mary L Quiel |
Corporate Officer |
Feb 1, 2015 | |
| Susie D Slinkard |
Corporate Officer |
Feb 1, 2015 | |
| Rick a Graves |
Corporate Officer |
Feb 1, 2015 | |
| Dianne C Langer |
Corporate Officer |
Feb 1, 2015 | |
| Douglas C Dayhoff |
Corporate Officer |
Feb 1, 2015 | |
| Greene County Health Inc |
5% Or Greater Direct Ownership Interest | Feb 27, 2015 | 100% |
| Crystal Plano |
Corporate Officer |
Feb 1, 2015 | |
| Corporate Director |
Feb 1, 2015 | ||
| W-2 Managing Employee |
Feb 1, 2015 | ||
| Operational/Managerial Control |
Feb 1, 2015 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Greene County Health Linton |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 27, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160520000216 | IN | Part B Supplier - Clinic/Group Practice | 7214226844 |
Receives reassigned benefits from 9 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jasonville, IN; Linton, IN |
| O20170712003419 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 7214226844 |
1 other NPI on this enrollment Practice locations: Jasonville, IN |
National Provider Directory
Locations
326 E Main St
Jasonville, IN 47438
Phone (812) 665-9000
1216 N 1000 W
Linton, IN 47441
Phone (812) 699-4111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
326 E Main St
Jasonville, IN 47438-1510
Mailing address
1210 N 1000 W
Linton, IN 47441-5013
Phone (812) 699-4153
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201359410A | Medicaid | IN | |
| 1194191536 | Other | IN | GROUP NPI |
Other providers in Jasonville, IN
- Kimberly Brooke Evol
- FCP Inc.
- James Franklin Forster IV
- Billie Jo Fritch
- Greene County General Hospital
- Jasonville SNF Opco LLC
- Ayrica S Keller
- Karin McKnight
- Samuel Edward Messmer
- MSD of Shakamak
All providers in Jasonville, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.