NPIMap

Organization Active NPI

Greene County Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Jasonville, IN
National Provider Identifier
1386042653
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Crystal Plano
Title
Cfo
Phone
(812) 699-4153

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386042653. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 27, 2015 in IN
Enrollment address
326 E Main St
Jasonville, IN 47438-1510

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2063508Greene County Health Inc326 E Main St, Jasonville, IN 47438Certificate of waiverAug 4, 2027

National Provider Directory

National Provider Directory

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
Dennis Green Individual Corporate OfficerBoard Member Feb 1, 2017
Lianne E Wilson Individual Corporate OfficerBoard Member Feb 1, 2015
Elizabeth M Burrows Individual Corporate OfficerInterim Ceo Feb 1, 2015
Corporate DirectorInterim Ceo Feb 1, 2015
W-2 Managing EmployeeInterim Ceo Feb 1, 2015
Operational/Managerial ControlInterim Ceo Feb 1, 2015
Sue Ann Johnson Individual Corporate OfficerBoard Member Feb 1, 2017
Linda D Bedwell Individual Corporate OfficerSecretary Feb 1, 2015
Corporate DirectorSecretary Feb 1, 2015
W-2 Managing EmployeeSecretary Feb 1, 2015
Operational/Managerial ControlSecretary Feb 1, 2015
Mary L Quiel Individual Corporate OfficerChairman Feb 1, 2015
Susie D Slinkard Individual Corporate OfficerBoard Member Feb 1, 2015
Rick a Graves Individual Corporate OfficerBoard Member Feb 1, 2015
Dianne C Langer Individual Corporate OfficerVice Chairman Feb 1, 2015
Douglas C Dayhoff Individual Corporate OfficerBoard Member Feb 1, 2015
Greene County Health Inc Organization, Jasonville, IN Corporation 5% Or Greater Direct Ownership Interest Feb 27, 2015 100%
Crystal Plano Individual Corporate OfficerCeo Feb 1, 2015
Corporate DirectorCeo Feb 1, 2015
W-2 Managing EmployeeCeo Feb 1, 2015
Operational/Managerial ControlCeo Feb 1, 2015

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Greene County Health LintonLinton, IN, CCN 151987 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2017

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1418860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1386042653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 N 1000 W",
            "city": "LINTON",
            "state": "IN",
            "postal_code": "474415013",
            "telephone_number": "812-699-4153",
            "fax_number": "812-699-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 E MAIN ST",
            "city": "JASONVILLE",
            "state": "IN",
            "postal_code": "474381510",
            "telephone_number": "812-665-9000",
            "fax_number": "812-665-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE COUNTY HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-18",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "PLANO",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-699-4153"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasonville, IN

Sources for this page

Verify at the official NPI Registry.