NPIMap

Organization Active NPI

Good Samaritan Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Washington, IN
National Provider Identifier
1386480911
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
GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Practice address
608 E Walnut St
Washington, IN 47501-2812
Phone
(812) 494-9514
Fax
(812) 494-9515
NPI assigned
Jul 3, 2024
Organization subpart
Yes
Parent organization
GOOD SAMARITAN FAMILY HEALTH CENTER, INCAs reported in NPPES

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
Jennifer Emmons
Title
Ceo
Phone
(812) 494-9501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

608 E Walnut St
Washington, IN 47501-2812

Mailing address

PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501

Other names 1

  • Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241218003648 IN Part A Provider - Federally Qualified Health Center (FQHC) 5294099321 Practice locations: Washington, IN

Federally qualified health center certification: CCN C51075

Legal name
GOOD SAMARITAN FAMILY HEALTH CENTER INC
Doing business as
FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 12, 2024
Last certification
Dec 12, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
608 E Walnut St
Washington, IN 47501-2812

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Family Health Center Inc30 organizations share this tax ID, including this one
Part of
Good Samaritan Family Health Center Inc

Other organizations with this tax ID 29

Organizations that report the same tax identification number in the National Provider Directory.

View all 29

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stanley Graber Individual Corporate DirectorCfo Dec 9, 2024
Bridgett Bilskie Individual W-2 Managing EmployeePayor Contract Manager Dec 9, 2024
Kolby Kerzan Individual OtherBoard Chairman Dec 9, 2024
Jennifer Emmons Individual 5% Or Greater Direct Ownership InterestCeo Dec 9, 2024 100%
Traci French Individual Corporate OfficerCao Dec 9, 2024

NPI Registry JSON

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1386480911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 556",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475910556",
            "telephone_number": "812-494-9501",
            "fax_number": "812-494-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 E WALNUT ST",
            "city": "WASHINGTON",
            "state": "IN",
            "postal_code": "475012812",
            "telephone_number": "812-494-9514",
            "fax_number": "812-494-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "EMMONS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-494-9501"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, IN

Sources for this page

Verify at the official NPI Registry.