NPIMap

Organization Active NPI

Deaconess Specialty Physicians, Inc

  • Cardiovascular Disease Physician
  • Newburgh, IN
National Provider Identifier
1477041556
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
DEACONESS SPECIALTY PHYSICIANS, INC
Practice address
4015 Gateway Blvd Ste 2120
Newburgh, IN 47630
Phone
(812) 450-7899
Fax
(812) 450-6029
NPI assigned
Apr 25, 2018
Last updated
May 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Authorized official

Name
Cheryl Annette Wathen
Title
Secretary/Treasurer
Phone
(812) 450-3296

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

4015 Gateway Blvd Ste 2120
Newburgh, IN 47630

Mailing address

PO Box 1230
Evansville, IN 47706-1230
Phone (812) 450-7899

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180702001637 IN Part B Supplier - Clinic/Group Practice 0244595205 Receives reassigned benefits from 283 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newburgh, IN; Washington, IN; Vincennes, IN; Santa Claus, IN; Princeton, IN; Linton, IN; Jasper, IN; Evansville, IN…

Other NPIs on the same Medicare enrollment 30

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

View all 30

National Provider Directory

National Provider Directory

Locations

4007 Gateway Blvd
Ste 100
Newburgh, IN 47630
Phone (812) 842-0907

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1477041556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1230",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061230",
            "telephone_number": "812-450-7899",
            "fax_number": "812-450-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 GATEWAY BLVD STE 2120",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "47630",
            "telephone_number": "812-450-7899",
            "fax_number": "812-450-6029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS SPECIALTY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.