NPIMap

Organization Active NPI

Deaconess Hospital, Inc

  • Sleep Medicine (Internal Medicine) Physician
  • Evansville, IN
National Provider Identifier
1497187397
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
Legal business name
DEACONESS HOSPITAL, INC
Practice address
7307 E Columbia St
Suite 101
Evansville, IN 47715
Phone
(812) 473-1737
Fax
(812) 450-6747
NPI assigned
Aug 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Authorized official

Name
Cheryl A Wathen
Title
Cfo
Phone
(812) 450-3296

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X Primary
Sleep Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084S0012X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X

Addresses

Primary practice location

7307 E Columbia St
Suite 101
Evansville, IN 47715

Mailing address

PO Box 3407
Evansville, IN 47733-3407
Phone (812) 473-1737

Other identifiers 1

IdentifierTypeStateIssuer
200226410IMedicaidIN

Other names 1

  • Deaconess Sleep Center East Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000129 IN Part B Supplier - Clinic/Group Practice 9032021431 Receives reassigned benefits from 719 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evansville, IN; Newburgh, IN
O20200610002146 KY Part B Supplier - Clinic/Group Practice 9032021431 Receives reassigned benefits from 142 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henderson, KY; Owensboro, KY

Other NPIs on the same Medicare enrollment 47

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

View all 47

National Provider Directory

National Provider Directory
Tax ID family
Tom P Martin MD46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

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": "1375315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1497187397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3407",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477333407",
            "telephone_number": "812-473-1737",
            "fax_number": "812-450-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7307 E COLUMBIA ST",
            "address_2": "SUITE 101",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47715",
            "telephone_number": "812-473-1737",
            "fax_number": "812-450-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-01",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200226410I",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Sleep Center East",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Deaconess Sleep Center East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.