NPIMap

Organization Active NPI

Good Samaritan Hospital

Doing business as Good Samaritan Family Practice 110

  • Rural Health Clinic/Center
  • Vincennes, IN
National Provider Identifier
1396408407
Registry record updated Sep 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GOOD SAMARITAN HOSPITAL
Doing business as
Good Samaritan Family Practice 110
Good Samaritan Hospital Convenient Care Clinic and Family Practice
Practice address
1813 Willow St Ste 6a
Vincennes, IN 47591-4279
Phone
(812) 885-6840
Fax
(812) 885-6841
NPI assigned
Oct 15, 2021
Last updated
Sep 8, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SAMARITAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2026

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

Authorized official

Name
Adam Thacker
Title
Ceo
Phone
(812) 882-5220

Specialties & licenses 1

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

Addresses

Primary practice location

1813 Willow St Ste 6a
Vincennes, IN 47591-4279

Mailing address

1160 E Saint Clair St
Vincennes, IN 47591-4853
Phone (812) 885-3325

Other names 2

  • Good Samaritan Family Practice 110 Doing business as
  • Good Samaritan Hospital Convenient Care Clinic and Family Practice Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.datavant.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230802001216 IN Part A Provider - Rural Health Clinic 9436061918 Practice locations: Vincennes, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396408407. Details of each certification follow.

Rural health clinic certification: CCN 158583

Legal name
GOOD SAMARITAN HOSPITAL
Doing business as
GOOD SAMARITAN FAMILY PRACTICE 110
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 31, 2024
Last certification
Jan 31, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Apr 1, 1903 in IN
Enrollment address
406 N 1St St
Ste a
Vincennes, IN 47591-1358
Related CCNs
150042

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Samaritan Center38 organizations share this tax ID, including this one
Part of
Samaritan Center

Other organizations with this tax ID 37

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

View all 37

Locations

406 N 1st St
Ste J
Vincennes, IN 47591
Phone (812) 882-4694

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Matthew Schuckman Individual Corporate OfficerCfo Jan 1, 2023
Carolyn Gordon Individual W-2 Managing EmployeeCredentialing Specialist Jan 1, 2023
Stanley Dewesse Individual Corporate DirectorSecretary Jan 1, 2023
Mary C Martin Individual Corporate DirectorVice-Chair Jan 1, 2023
Robert D McLin Individual Corporate OfficerCeo Jan 1, 2023
Billie Hawkins Individual W-2 Managing EmployeeCredentialing Specialist Jan 1, 2023
Susan Brocksmith Individual Corporate DirectorChairman Jan 1, 2023

All facility ownership & control disclosures 17

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

FacilityTypeRoleSince
Good Samaritan HospitalVincennes, IN, CCN 150042 Hospital Other Apr 5, 2015
Amber Manor Care CenterPetersburg, IN, CCN 155361 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 May 1, 2015
May 1, 2015
Jul 31, 2025
St Charles Health CampusJasper, IN, CCN 155674 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
West River Health CampusEvansville, IN, CCN 155785 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
River Pointe Health CampusEvansville, IN, CCN 155723 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
Oakwood Health CampusTell City, IN, CCN 155671 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
Woodmont Health CampusBoonville, IN, CCN 155682 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
Riveroaks Health CampusPrinceton, IN, CCN 155732 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
Scenic Hills at the MonasteryFerdinand, IN, CCN 155493 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
Bridgepointe Health CampusVincennes, IN, CCN 155696 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 May 1, 2015
May 1, 2015
Jun 23, 2025
Terrace at Solarbron theEvansville, IN, CCN 155773 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2016
North River Health CampusEvansville, IN, CCN 155854 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 1, 2015
May 1, 2015
Good Samaritan Home Care Services of Vincennes in, LLCVincennes, IN, CCN 157217 Home health agency 5% Or Greater Direct Ownership Interest (50%) Dec 1, 2004
Good Samaritan Home Care ServicesLawrenceville, IL, CCN 148377 Home health agency 5% Or Greater Direct Ownership Interest (50%) Mar 1, 2018
Good Samaritan Hospital Physician Services, IncVincennes, IN, CCN 153912 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2011
Good Samaritan Internal Medicine 100Vincennes, IN, CCN 158585 Rural health clinic Operational/Managerial Control
Other		 Jan 1, 2023
Jan 1, 2023
Good Samaritan Washington Primary CareWashington, IN, CCN 158594 Rural health clinic Operational/Managerial Control (100%)
Other		 Jun 1, 2025
Jun 1, 2025

Owned or controlled facilities with NPI records 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 4

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": "1634256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788825600000",
    "number": "1396408407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 E SAINT CLAIR ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914853",
            "telephone_number": "812-885-3325",
            "fax_number": "812-885-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 WILLOW ST STE 6A",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914279",
            "telephone_number": "812-885-6840",
            "fax_number": "812-885-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN HOSPITAL",
        "enumeration_date": "2021-10-15",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A",
        "authorized_official_last_name": "THACKER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-882-5220"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.datavant.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Good Samaritan Family Practice 110",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Samaritan Hospital Convenient Care Clinic and Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.