NPIMap

Organization Active NPI

Good Samaritan Family Health Center, Inc

Doing business as Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Vincennes, IN
National Provider Identifier
1487424628
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Doing business as
Family Health Center
Practice address
1513 Main St FL 3
Vincennes, IN 47591-6238
Phone
(812) 885-2720
Fax
(812) 885-2722
NPI assigned
Jan 8, 2024
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SAMARITAN FAMILY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Jennifer Emmons
Title
Ceo
Phone
(812) 494-9501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1513 Main St FL 3
Vincennes, IN 47591-6238

Mailing address

PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501

Other names 1

  • Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240621000284 IN Part A Provider - Federally Qualified Health Center (FQHC) 5294099321 Practice locations: Vincennes, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487424628. Details of each certification follow.

Federally qualified health center certification: CCN C51041

Legal name
GOOD SAMARITAN FAMILY HEALTH CENTER INC
Doing business as
FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 18, 2024
Last certification
Jun 18, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 25, 2017 in IN
Enrollment address
1513 Main St
FL 3
Vincennes, IN 47591-6238

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Family Health Center Inc31 organizations share this tax ID, including this one
Part of
Good Samaritan Family Health Center Inc

Other organizations with this tax ID 30

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

View all 30

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Stanley Graber Individual Corporate OfficerCfo Jul 1, 2023
Bridgett Bilskie Individual W-2 Managing EmployeePayor Contract Management Jul 1, 2023
Stormey Wiegman Individual W-2 Managing EmployeeProvider Enrollment Specialist Apr 15, 2024
Kolby Kerzan Individual OtherBoard Chairman Sep 1, 2023
Jennifer Emmons Individual 5% Or Greater Direct Ownership InterestCeo Jul 1, 2023 100%
Traci French Individual Corporate OfficerCao Jul 1, 2023

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1487424628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 556",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475910556",
            "telephone_number": "812-494-9501",
            "fax_number": "812-494-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 MAIN ST FL 3",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475916238",
            "telephone_number": "812-885-2720",
            "fax_number": "812-885-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "EMMONS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-494-9501"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.