NPIMap

Organization Active NPI

Deaconess Clinic Inc

Doing business as Deaconess Clinic Morganfield

  • Rural Health Clinic/Center
  • Morganfield, KY
National Provider Identifier
1467027664
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DEACONESS CLINIC INC
Doing business as
Deaconess Clinic Morganfield
Practice address
1284 US Highway 60 W
Morganfield, KY 42437-6236
Phone
(270) 389-2323
Fax
(270) 389-0526
NPI assigned
May 21, 2021
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Cheryl Annette Wathen
Title
Cfo
Phone
(812) 450-3296

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1284 US Highway 60 W
Morganfield, KY 42437-6236

Mailing address

PO Box 638705
Cincinnati, OH 45263-8705
Phone (270) 389-2323

Other names 1

  • Deaconess Clinic Morganfield Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20081017000259 KY Part B Supplier - Clinic/Group Practice 3375610116 Receives reassigned benefits from 190 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sebree, KY; Philpot, KY; Owensboro, KY; Morganfield, KY; Madisonville, KY; Henderson, KY; Dixon, KY
O20210811002781 KY Part B Supplier - Clinic/Group Practice 5799189866 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dixon, KY; Morganfield, KY
O20230202003269 KY Part A Provider - Rural Health Clinic 3375610116 Practice locations: Morganfield, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467027664. Details of each certification follow.

Rural health clinic certification: CCN 183968

Legal name
DEACONESS CLINIC INC
Doing business as
DEACONESS CLINIC MORGANFIELD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2023
Last certification
Oct 3, 2013
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 2008 in IN
Enrollment address
1284 US Highway 60 W
Morganfield, KY 42437-6236

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 31

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

View all 31

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
18D0326658Deaconess Morganfield Clinic RHC1284 US Hwy 60 West, Morganfield, KY 42437Certificate of waiverJun 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Clinic Inc101 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1284 US Highway 60 W
Morganfield, KY 42437
Phone (270) 389-2323

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Mia Souheil Hindi Individual Corporate DirectorBoard Member Oct 1, 2015
Majed a Koleilat Individual Corporate DirectorBoard Member Oct 1, 2012
Garrett C Koon Individual Corporate DirectorBoard Member Oct 1, 2020
Ashley Lynn Richeson Individual Corporate DirectorBoard Member Oct 1, 2020
Renee Michelle Galen Individual Corporate DirectorBoard Member Oct 1, 2012
Deaconess Health System Inc Organization, Evansville, IN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2008 100%
Snesha Modi Individual Corporate DirectorBoard Member Oct 1, 2020
William R Smith Individual Corporate DirectorBoard Member Oct 1, 2015
Jason F White Individual Corporate DirectorBoard Member Oct 1, 2022
Barry S Phillips Individual Corporate DirectorBoard Member Oct 1, 2015
Jamie L Mull Individual Corporate DirectorBoard Member Oct 1, 2021
Cheryl Wathen Individual Corporate OfficerCfo Oct 1, 2012
Stephen T Titzer Individual Corporate DirectorBoard Member Oct 1, 2012
Shawn W McCoy Individual Operational/Managerial ControlCeo Jan 1, 2012
Chris E Chacko Individual Corporate DirectorBoard Member Oct 1, 2019
Gary J Keepes Individual Corporate DirectorBoard Member Oct 1, 2019
Dhruvin Mehta Individual Corporate DirectorBoard Member Oct 1, 2022

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 28

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

View all 28

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2023 Change of OwnershipThis provider was the buyer Deaconess Union County MorganfieldCCN 183968, KY, NPI 1467027664
Jan 1, 2023 Change of OwnershipThis provider was the seller Deaconess Clinic MorganfieldCCN 183968, KY, NPI 1467027664

Practitioners & affiliated clinicians

Practitioners 5

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": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1467027664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638705",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452638705",
            "telephone_number": "270-389-2323",
            "fax_number": "270-389-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1284 US HIGHWAY 60 W",
            "city": "MORGANFIELD",
            "state": "KY",
            "postal_code": "424376236",
            "telephone_number": "270-389-2323",
            "fax_number": "270-389-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Clinic Morganfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morganfield, KY

Sources for this page

Verify at the official NPI Registry.