NPIMap

Organization Active NPI

St. Vincent Williamsport Hospital

Doing business as Ascension St. Vincent Williamsport

  • Critical Access Hospital
  • Williamsport, IN
National Provider Identifier
1427128404
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
050050921 Issued in IN
Legal business name
ST. VINCENT WILLIAMSPORT HOSPITAL
Doing business as
Ascension St. Vincent Williamsport
Practice address
412 N Monroe St
Williamsport, IN 47993-1049
Phone
(765) 762-4000
NPI assigned
Nov 8, 2006
Last updated
Aug 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. VINCENT WILLIAMSPORT HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Authorized official

Name
Trina Marlatt, RN, MSN
Title
Administrator
Phone
(765) 762-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 050050921 IN Primary

Addresses

Primary practice location

412 N Monroe St
Williamsport, IN 47993-1049

Mailing address

412 N Monroe St
Williamsport, IN 47993-1049
Phone (765) 762-4000

Other names 1

  • Ascension St. Vincent Williamsport Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080103000116 IN Part A Provider - Critical Access Hospital 4486636776 Practice locations: Williamsport, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427128404. Details of each certification follow.

Hospital certification: CCN 15Z307

Legal name
ST VINCENT WILLIAMSPORT HOSPITAL
Doing business as
ASCENSION ST. VINCENT WILLIAMSPORT
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 1944 in IN
Enrollment address
412 N Monroe St
Williamsport, IN 47993-1049
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
St Vincent Williamsport Hospital7 organizations share this tax ID, including this one
Part of
St Vincent Williamsport Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the 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
Jacob Steve Baker Individual Corporate DirectorBoard Member Jul 1, 2023
Kevin P Speer Individual Corporate DirectorBoard Member Jul 1, 2023
Cynthia Dawn Adams Individual Corporate DirectorBoard Member Jul 1, 2023
Carlyle Floyd Individual Corporate DirectorBoard Member Jul 1, 2023
Floyd Grubb Individual Corporate Director Nov 29, 2007
Melanie Craigin Individual Corporate OfficerCeo & Administrator Jul 1, 2013 50%
W-2 Managing EmployeeCeo & Administrator Nov 29, 2007 50%
Michael Todd Emmons Individual Corporate DirectorBoard Member Jul 1, 2023
Dana M Muntz Individual Corporate OfficerVP of Rural Healthcare Jul 1, 2023
Corporate DirectorBoard Member Jul 1, 2023
W-2 Managing EmployeeVP of Rural Healthcare Jul 1, 2023
Brian Edwards Individual Corporate DirectorBoard Member Jul 1, 2023
Ascension Health Organization, Saint Louis, MO Non-profit Operational/Managerial Control Jun 11, 2014
St Vincent Health Inc Organization, Indianapolis, IN Non-profit Operational/Managerial Control Jun 11, 2014 100%
Ryan Penrod Individual Corporate DirectorBoard Member Jul 1, 2023

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 2

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

FacilityTypeRoleSince
Ascension St. Vincent WilliamsportWilliamsport, IN, CCN 151307 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 8, 1966
Ascension St. Vincent WilliamsportWilliamsport, IN, CCN 153993 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 3, 2001
May 3, 2001

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 166

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

View all 166

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1427128404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 N MONROE ST",
            "city": "WILLIAMSPORT",
            "state": "IN",
            "postal_code": "479931049",
            "telephone_number": "765-762-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 N MONROE ST",
            "city": "WILLIAMSPORT",
            "state": "IN",
            "postal_code": "479931049",
            "telephone_number": "765-762-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT WILLIAMSPORT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. VINCENT WILLIAMSPORT HOSPITAL, INC",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "MARLATT",
        "authorized_official_first_name": "TRINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "765-762-4000",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IN",
            "license": "050050921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent Williamsport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, IN

Sources for this page

Verify at the official NPI Registry.