NPIMap

Organization Active NPI

Community Hospital of Bremen, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Bremen, IN
National Provider Identifier
1477597631
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
05-005097-2 Issued in IN
Legal business name
COMMUNITY HOSPITAL OF BREMEN, INC.
Practice address
1020 High Rd
Bremen, IN 46506-1093
Phone
(574) 546-2211
Fax
(574) 546-4312
NPI assigned
Jun 16, 2006
Last updated
Jan 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2016

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

Authorized official

Name
Mr. David Bailey, FACHE
Title
President/Ceo
Phone
(574) 546-2211

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 05-005097-2 IN Primary
Medicare Defined Swing Bed Hospital Unit 275N00000X 140050971 IN

Addresses

Primary practice location

1020 High Rd
Bremen, IN 46506-1093

Mailing address

1020 High Rd
Bremen, IN 46506-1093
Phone (574) 546-2211

Other names 1

  • Community Hospital of Bremen Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111214000858 IN Part A Provider - Critical Access Hospital 6002897451 Practice locations: Bremen, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477597631. Details of each certification follow.

Hospital certification: CCN 15Z300

Legal name
COMMUNITY HOSPITAL OF BREMEN INC
Doing business as
COMMUNITY HOSPITAL OF BREMEN INC
Organization structure
CorporationNon-profit
Incorporated
Apr 26, 1948 in IN
Enrollment address
1020 High Rd
Bremen, IN 46506-1093

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Community Hospital of B4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Andrew Wolf Individual Corporate DirectorMember Board of Directors Jun 1, 2012
Irene Maffetone Individual W-2 Managing Employee Jun 14, 2018
Norma Napoli Individual Corporate DirectorMember Board of Directors Jun 1, 2007
Beacon Health System Inc Organization, South Bend, IN Corporation 5% Or Greater Indirect Ownership Interest Jun 14, 2018 100%
Carol Hochstetler Individual Corporate OfficerChairman Board of the Directors Jun 1, 2012
Jeffrey P Costello Individual Corporate OfficerCfo Jun 14, 2018 100%
Amy Lashbrook Individual Corporate OfficerVP of Finance/Cfo Aug 18, 2014
W-2 Managing EmployeeVP of Finance/Cfo Aug 18, 2014
David Bailey Individual Corporate Officer Mar 18, 2013
W-2 Managing EmployeePresident/Ceo Mar 18, 2013
Karen Shorter Individual Corporate DirectorMember Board of Directors Jun 1, 2009
Thomas Teghtmeyer Individual Corporate OfficerVice Chairman Board of the Direc Jun 1, 2012
Jeff Brinkman Individual Corporate OfficerSecretary Board of Directors Jun 1, 2012
James Richardson Individual Corporate DirectorMember Board of Directors Jun 1, 2012
William Davis Individual Corporate OfficerTreasurer-Board of Directors Jun 1, 2012
Alan Miller Individual Corporate DirectorMemberboard of Directors Jun 1, 2009

Facilities with the same owner 21

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

View all 21

Practitioners & affiliated clinicians

Practitioners 9

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.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452643200000",
    "number": "1477597631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 HIGH RD",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "465061093",
            "telephone_number": "574-546-2211",
            "fax_number": "574-546-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 HIGH RD",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "465061093",
            "telephone_number": "574-546-2211",
            "fax_number": "574-546-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL OF BREMEN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2016-01-13",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "574-546-2211",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FACHE"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IN",
            "license": "05-005097-2",
            "primary": true
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IN",
            "license": "140050971",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Hospital of Bremen",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bremen, IN

Sources for this page

Verify at the official NPI Registry.