St. Vincent Madison County Health System, Inc
Organization Active NPI Critical Access Hospital · Elwood, IN
NPI 1477508596 · NPPES record last updated May 19, 2014
Key facts
- NPI
- 1477508596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 060050832 (IN)
- Legal business name
- ST. VINCENT MADISON COUNTY HEALTH SYSTEM, INC
- Practice address
- 1331 S a St
Elwood, IN 46036-1942 - Phone
- (765) 552-4600
- Fax
- (765) 552-4775
- NPI assigned
- May 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Ann Yates
- Title
- Director of Nursing, St. Vincent Me
- Phone
- (765) 552-4600
Owners & managing parties with NPI records 1
-
Michael T Emmons, DO
Other NPIs with the same Medicare PAC ID 1
Related certifications (CCN) 1
Facilities with the same owner 166
Affiliated clinicians 44
-
Audrey R Alcala, FNP
-
Tammy J Biele, NP
-
Thomas Bright, MD
-
Ravneet Kaur Dhillon, M.D
-
Ronald Duncan, MD
-
Scott Friedman, MD
-
Haylee Goad, FNP-C
-
Mahesh C Goel, MD
-
Nathan Graves, D.P.M.
-
Bradley L. Hayes, MD
-
Anthony S Hill, MD
-
Joseph G. Jerman, MD
-
Preetham Jetty, MD
-
William Anthony Jones, CRNA
-
Kerry Anne Kane, APRN BC
-
John Peter Klim, DO
-
Glen E Leer, D.O.
-
David C Mares, MD
-
Pablo Molina, MD
Medicare Care Compare: Hospital
- Listed as
- Ascension St Vincent Mercy
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Church
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0352313 | Ascension St Vincent Mercy Hospital | Accreditation | Aug 16, 2027 |
| 15D2078199 | Amin FRZN Section Lab at St Vincent Mercy Hosp | Accreditation | Dec 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Hospital certification: CCN 151308
- Legal name
- ST. VINCENT MADISON COUNTY HEALTH SYSTEM, INC.
- Doing business as
- ASCENSION ST. VINCENT MERCY
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Jul 2, 2001
- Last certification
- Jul 10, 2014
- Beds
- 25
- Ownership / control type
- Church
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 30, 1955 in IN
- Enrollment address
- 1331 S a St
Elwood, IN 46036-1942
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Jacob Steve Baker |
Corporate Director |
Jul 1, 2023 | |
| Kevin P Speer |
Corporate Officer |
May 1, 2023 | |
| Cynthia Dawn Adams |
Corporate Director |
Jul 1, 2018 | |
| Carlyle Floyd |
Corporate Director |
Jul 1, 2023 | |
| Floyd Grubb |
Corporate Director |
Jul 1, 2023 | |
| Michael Todd Emmons |
Corporate Director |
Jul 1, 2023 | |
| Dana M Muntz |
Corporate Officer |
Jul 1, 2023 | |
| Corporate Director |
Jul 1, 2023 | ||
| W-2 Managing Employee |
Jul 1, 2023 | ||
| Ann Yates |
Corporate Officer |
Jul 1, 2023 | |
| W-2 Managing Employee | Jul 1, 2023 | ||
| Brian Edwards |
Corporate Director |
Jul 1, 2018 | |
| Ascension Health |
Operational/Managerial Control | Oct 17, 2003 | |
| St Vincent Health Inc |
5% Or Greater Direct Ownership Interest | Nov 23, 2010 | 100% |
| Ryan Penrod |
Corporate Director |
Jul 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131216000577 | IN | Part a Provider - Critical Access Hospital | 2961493614 | Practice locations: Elwood, IN |
National Provider Directory
Locations
2350 Reliable Pkwy
Chicago, IL 60686
6002 Reliable Pkwy
Chicago, IL 60686
141 W 22nd St
Ste 109
Anderson, IN 46016
Phone (317) 871-6123
101 S Main St
Fairmount, IN 46928
105 S Main St
Fairmount, IN 46928
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 060050832 | IN | Yes |
Addresses
Primary practice location
1331 S a St
Elwood, IN 46036-1942
Mailing address
1331 S a St
Elwood, IN 46036-1942
Phone (765) 552-4600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100268360 | Medicaid | IN |
Other names
- St. Vincent Mercy Hospital
Other providers in Elwood, IN
- Elizabeth VI Simpson
- Melanie J Smith-Sanders
- Carolyn P Smith
- Gail L Smith
- Mina Soliman
- St. Vincent Madison County Health System, Inc.
- St. Vincent Madison County Health System, Inc.
- St. Vincent Madison County Health System, Inc.
- St. Vincent Medical Group, Inc.
- Megan Stowers
All providers in Elwood, IN · Critical Access Hospital in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2014. 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.