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Community Hospital of Bremen, Inc.

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Bremen, IN

NPI 1477597631 · NPPES record last updated Jan 13, 2016

Key facts

NPI
1477597631
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
05-005097-2 (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
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 3

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

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

Facilities with the same owner 21

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

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN

Hospital certification: CCN 15Z300

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

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 Director
Member Board of Directors		 Jun 1, 2012
Irene Maffetone
Individual 		W-2 Managing Employee Jun 14, 2018
Norma Napoli
Individual 		Corporate Director
Member 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 Officer
Chairman Board of the Directors		 Jun 1, 2012
Jeffrey P Costello
Individual 		Corporate Officer
Cfo		 Jun 14, 2018 100%
Amy Lashbrook
Individual 		Corporate Officer
VP of Finance/Cfo		 Aug 18, 2014
W-2 Managing Employee
VP of Finance/Cfo		 Aug 18, 2014
David Bailey
Individual 		Corporate Officer Mar 18, 2013
W-2 Managing Employee
President/Ceo		 Mar 18, 2013
Karen Shorter
Individual 		Corporate Director
Member Board of Directors		 Jun 1, 2009
Thomas Teghtmeyer
Individual 		Corporate Officer
Vice Chairman Board of the Direc		 Jun 1, 2012
Jeff Brinkman
Individual 		Corporate Officer
Secretary Board of Directors		 Jun 1, 2012
James Richardson
Individual 		Corporate Director
Member Board of Directors		 Jun 1, 2012
William Davis
Individual 		Corporate Officer
Treasurer-Board of Directors		 Jun 1, 2012
Alan Miller
Individual 		Corporate Director
Memberboard of Directors		 Jun 1, 2009

Medicare enrollment records

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

National Provider Directory

Tax ID family
Community Hospital of B (4 organizations share this tax ID)

Specialties & licenses

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

  • Community Hospital of Bremen Other name

Other providers in Bremen, IN

All providers in Bremen, IN · Medicare Defined Swing Bed Hospital Unit in Indiana

Sources for this page

Verify at the official NPI Registry.