NPIMap

Organization Active NPI

Perry County Memorial Hospital

  • Rural Health Clinic/Center
  • Rockport, IN
National Provider Identifier
1487217121
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PERRY COUNTY MEMORIAL HOSPITAL
Practice address
105 S 2ND St
Rockport, IN 47635-1318
Phone
(812) 649-2271
NPI assigned
Apr 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Authorized official

Name
Crystal Lee Hinton
Title
Provider Enrollment
Phone
(812) 772-0589

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

105 S 2ND St
Rockport, IN 47635-1318

Mailing address

8885 State Road 237
Tell City, IN 47586-8567
Phone (812) 547-7011

Other identifiers 3

IdentifierTypeStateIssuer
7100315860MedicaidKY
7100653040MedicaidKY
300033542MedicaidIN

Other names 1

  • Spencer County Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040909000009 IN Part B Supplier - Clinic/Group Practice 6901871276 Receives reassigned benefits from 44 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Leopold, IN; Tell City, IN; Rockport, IN
O20210225003331 IN Part A Provider - Rural Health Clinic 6901871276 Practice locations: Rockport, IN

Rural health clinic certification: CCN 158562

Legal name
PERRY COUNTY MEMORIAL HOSPITAL
Doing business as
SPENCER COUNTY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 24, 2021
Last certification
Mar 24, 2021
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
105 S 2ND St
Rockport, IN 47635-1318
Related CCNs
151322

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2146538Spencer County Clinic105 South 2ND Street, Rockport, IN 47635Certificate of waiverApr 1, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
James R Childers Individual Corporate OfficerCfo Sep 15, 2018
W-2 Managing EmployeeCfo Sep 15, 2018
Brian J Herwig Individual Corporate OfficerCeo Aug 15, 2018
W-2 Managing EmployeeCeo Aug 15, 2018

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Perry County Memorial HospitalTell City, IN, CCN 151322 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Perry County Memorial HospitalTell City, IN, CCN 15Z322 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Perry County Memorial HospitalTell City, IN, CCN 157177 Home health agency Operational/Managerial Control (100%) Jan 5, 2012
Tell City ClinicTell City, IN, CCN 158516 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2019
Oct 1, 2019
Leopold ClinicLeopold, IN, CCN 158517 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2019
Oct 1, 2019

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1487217121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8885 STATE ROAD 237",
            "city": "TELL CITY",
            "state": "IN",
            "postal_code": "475868567",
            "telephone_number": "812-547-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S 2ND ST",
            "city": "ROCKPORT",
            "state": "IN",
            "postal_code": "476351318",
            "telephone_number": "812-649-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-18",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "HINTON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "812-772-0589"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100315860",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100653040",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300033542",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spencer County Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockport, IN

Sources for this page

Verify at the official NPI Registry.