Southern Indiana Community Health Care, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Mitchell, IN
NPI 1427768647 · NPPES record last updated Nov 29, 2022
Key facts
- NPI
- 1427768647
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
- Practice address
- 2759 State Road 37
Mitchell, IN 47446-6016 - Phone
- (812) 992-5440
- Fax
- (812) 992-5441
- NPI assigned
- Nov 29, 2022
- Organization subpart
- No
Authorized official
- Name
- Nancy Radcliff
- Title
- Ceo
- Phone
- (812) 723-3944
Owners & managing parties with NPI records 1
-
Yolanda Joy Yoder, M. D.
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Practitioners 23
-
Amanda Sue Bowman, NP-C
-
Lori D Day, NP
-
Kristi Jo Nissley, FNP-C
-
Tricia Jayne Spoonmore, FNP-C
-
Shannon Malena Dooley, N. P.
-
Heather Kearby, FNP
-
Ashley M. McCurry, D.O.
-
Brenda Kay Painter, FNP
-
Melissa Ann Ray, FNP
-
Sergio S. Sales, MD
-
Nancy S Stirling, D.O
-
Brittany Renae Stout, FNP, NP-C
-
Jaclynn Marie Thacker, APRN, NP-C
-
Curtis Carlyle Thill, M. D.
-
Elisabeth Ann Throop, FNP-C
-
Tyler Lee White, FNP-C
-
Yolanda Joy Yoder, M. D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2057277 | Southern Indiana Community Health Care, Inc | Certificate of waiver | May 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Federally qualified health center certification: CCN 151164
- Legal name
- SOUTHERN INDIANA COMMUNITY HEALTH CARE INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 20, 2022
- Last certification
- Dec 20, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 2759 State Road 37
Mitchell, IN 47446-6016
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Nancy Radcliff |
Corporate Officer |
Jan 1, 2022 | |
| Yolanda J Yoder |
Corporate Officer |
Jan 1, 2022 | |
| Sue Brock |
Corporate Officer |
Jan 1, 2022 | |
| W-2 Managing Employee |
Jan 1, 2022 | ||
| Evelyn Shellenberger |
Corporate Officer |
Jan 1, 2022 | |
| Ryan Engleking |
Corporate Officer |
Jan 1, 2022 | |
| Carrie Rahman |
Corporate Officer |
Jan 1, 2022 | |
| John Noblitt |
Corporate Officer | Jan 1, 2022 | |
| Floyd Chupp |
Corporate Officer | Jan 1, 2022 | |
| Nick Siler |
Corporate Officer | Jan 1, 2022 | |
| Carla McSpadden |
Corporate Officer | Jan 1, 2022 | |
| Mindy Babbitt |
Corporate Officer | Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040525000541 | IN | Part B Supplier - Clinic/Group Practice | 5799694360 |
Receives reassigned benefits from 37 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Orleans, IN; Paoli, IN |
| O20221222000890 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 5799694360 | Practice locations: Mitchell, IN |
National Provider Directory
- Tax ID family
- Comprehensive Health Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2759 State Road 37
Mitchell, IN 47446-6016
Mailing address
PO Box 270
Paoli, IN 47454-0270
Phone (812) 723-3944
Other providers in Mitchell, IN
- David B Sledge
- Jessica Smith
- Rebeka T Smith
- Snow Family Chiropractic LLC
- Southern Indiana Center for Independent Living, Inc
- Molly Sullivan
- Natalie Swayze
- Hayley Taylor
- Kyra Thorlton
- Aaliyah Tincher
All providers in Mitchell, 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 Nov 29, 2022. 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.