Elkhart General Hospital, Inc.
Organization Active NPI General Acute Care Hospital · Elkhart, IN
NPI 1477551489 · NPPES record last updated Oct 16, 2024
Key facts
- NPI
- 1477551489
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 05-005017-1 (IN)
- Legal business name
- ELKHART GENERAL HOSPITAL, INC.
- Practice address
- 600 East Blvd
Elkhart, IN 46514-2483 - Phone
- (574) 523-3200
- Fax
- (574) 523-3492
- NPI assigned
- Jul 13, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey Costello
- Title
- Cfo
- Phone
- (574) 647-3460
Other NPIs on the same Medicare enrollment 3
Facilities with the same owner 21
Practitioners 30
-
Anouk Danielle Shelton, MBA, RD, LD, CNSC
-
Gloria Jeanne Barker, CNS, APRN, BC
-
Jennifer S Bauer, NP
-
Kay L. Church, FNP
-
Luisito C. Gonzales, M.D.
-
Starla D Graber, M.D.
-
Martina A Green-McGowan, M.D.
-
Stephen P Hollenberg, M.D.
-
Karen C. James, ANP
-
Regina R. Jasiewicz, FNP
-
Rosalie L McBride, M.D.
-
Timothy E Morgan, MD
-
Shelley A. Morris, D.O.
-
Jill J Newcomer, NP-C
-
Roger A Pederson, LCSW
-
Michael C Rotkis, MD
-
Patrick W Russell, D.O.
-
John C Sorg, MD
-
David O. Taylor, M.D.
-
Lorraine E Weaver, M.D.
-
Jeannine Louise Everett, ARNP
Affiliated clinicians 535
-
Daniel Walter Abel, M.D.
-
Nicholas Abel, MD
-
Matthew Lee Abrell, DPM
-
Kimberlee Lynn Acton, FNP-C
-
Pavan Ahuja, M.D.
-
Rocio Ahuja, M.D.
-
Ismail Al-Ani, MD
-
Syed Ibrahim Ali, M.D
-
Kiesha Anderson, D.O.
-
Tamera J. Andrews, NP-C
-
Nicole Anest, M.D.
-
Christopher M. Annis, M.D.
-
Bilal Ansari, M.D.
-
Abuzafar M. Arif, M.D.
-
Kristen A Atwood, APN
-
Michelle R Bache, MD
-
Kathryn Bachman, DO
-
Angela Marie Ball, FNP
-
Natali M Balog, MD
Medicare Care Compare: Hospital
- Listed as
- Elkhart General Hospital
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Hospital certification: CCN 150018
- Legal name
- ELKHART GENERAL HOSPITAL INC
- Doing business as
- ELKHART GENERAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Mar 31, 2016
- Beds
- 297
- Ownership / control type
- Local
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 29, 1909 in IN
- Enrollment address
- 600 East Blvd
Elkhart, IN 46514-2483 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Kreg Gruber |
Corporate Officer |
Feb 24, 2016 | |
| W-2 Managing Employee |
Feb 24, 2016 | ||
| Irene Maffetone |
W-2 Managing Employee |
Feb 24, 2016 | |
| Beacon Health System Inc |
Operational/Managerial Control | Nov 23, 2011 | 100% |
| Jeffrey P Costello |
Corporate Officer |
Mar 1, 2012 | |
| Carl Risk |
Corporate Officer |
Sep 9, 2016 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031213000004 | IN | Part B Supplier - Clinic/Group Practice | 4688571169 |
Receives reassigned benefits from 2 practitioners 3 other NPIs on this enrollment Practice locations: Elkhart, IN |
| O20071226000283 | IN | Part a Provider - Hospital | 4688571169 | Practice locations: Elkhart, IN |
National Provider Directory
Locations
1625 Stockton Blvd
Ste 106
Sacramento, CA 95816
Phone (916) 262-9002
500 Arcade Ave
Ste 400
Elkhart, IN 46514
Phone (574) 522-2284
307 S Main St
Ste 305
Elkhart, IN 46516
Phone (219) 523-3347
303 S Nappanee St
#A
Elkhart, IN 46514
Phone (574) 296-3338
225 E Jackson Blvd
Elkhart, IN 46516
Phone (574) 523-3100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | |||
| General Acute Care Hospital | 282N00000X | 05-005017-1 | IN | Yes |
Addresses
Primary practice location
600 East Blvd
Elkhart, IN 46514-2483
Mailing address
600 East Blvd
Elkhart, IN 46514-2483
Phone (574) 294-2621
Other practice location 1
303 S Nappanee St Ste B
Elkhart, IN 46514-2066
Phone (574) 294-2621
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100268340A | Medicaid | IN |
Other providers in Elkhart, IN
- Elkhart General Hospital, Inc
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
- Elkhart General Hospital, Inc.
All providers in Elkhart, IN · General Acute Care 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 Oct 16, 2024. 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.