NPIMap

Organization Active NPI

Sullivan County Community Hospital

  • Critical Access Hospital
  • Sullivan, IN
National Provider Identifier
1497759260
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
005013 Issued in IN
Legal business name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Practice address
2200 N Section St
Sullivan, IN 47882-7523
Phone
(812) 268-4311
Fax
(812) 268-2650
NPI assigned
Jun 9, 2005
Last updated
Aug 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Ms. Michelle Franklin
Title
Ceo
Phone
(812) 268-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 005013 IN Primary

Addresses

Primary practice location

2200 N Section St
Sullivan, IN 47882-7523

Mailing address

PO Box 10
2200 N. Section Street
Sullivan, IN 47882-0010
Phone (812) 268-4311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20061104000528 IN Part A Provider - Critical Access Hospital 2466497482 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
Practice locations: Sullivan, IN
O20070817000379 IN Part B Supplier - Clinic/Group Practice 2466497482 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
Practice locations: Sullivan, IN
O20071113000516 IN Part A Provider - Critical Access Hospital 2466497482 Practice locations: Sullivan, IN

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1497759260. Details of each certification follow.

Hospital certification: CCN 151327

Legal name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Doing business as
SULLIVAN COUNTY COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jun 1, 2005
Last certification
Apr 8, 2015
Beds
25
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
2200 N Section St
Sullivan, IN 47882-7523
Other Hospital Practice Location

Hospital certification: CCN 15Z327

Legal name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Doing business as
SULLIVAN COUNTY COMMUNITY HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1966 in IN
Enrollment address
2200 N Section St
Sullivan, IN 47882-7523
Other Hospital Practice Location

Hospital certification: CCN 150013

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SULLIVAN COUNTY COMMUNITY HOSPITAL
Certification status
Terminated Other: provider status change, Jun 1, 2005
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 28, 1999
Beds
37
Ownership / control type
Local
Facility address
2200 North Section St
Sullivan, IN 47882

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sullivan County Community HospitalCCN 151327 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2200 N Section St
Ste 2A
Sullivan, IN 47882

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Jim Bishop Individual Corporate Officer Mar 1, 2018
Corporate Director Mar 1, 2018
Corporate Officer Mar 19, 2018
Vincent Bruce Walkup Individual Corporate DirectorBoard Member Jul 1, 2018 100%
Carrie Page Individual Corporate Director Jul 1, 2020
Jennifer Ridgway Individual Corporate Director Jun 21, 2021
W-2 Managing EmployeeRevenue Cycle Director Jun 21, 2021 100%
Corporate DirectorDirector of Revenue Cycle Jun 21, 2021 100%
W-2 Managing EmployeeDirector of Revenue Cycle Jun 21, 2021 100%
Alan Badger Individual Corporate DirectorBoard Member Jul 15, 2017 100%
Sarah E Hannon Individual Corporate DirectorBoard Member Jul 1, 2023 100%
Michelle R Franklin Individual Corporate Officer May 4, 2006
Corporate DirectorCeo May 4, 2006
Corporate OfficerChief Executive Officer May 1, 2006 100%
Thad L Pirtle Individual Corporate DirectorBoard Member Jul 1, 2023 100%
Quorum Health Resources LLC Organization, Brentwood, TN Consulting firm Operational/Managerial Control Sep 12, 2008
Chris Gentry Individual Corporate Director Aug 1, 2017
Sullivan County Community Hospital Organization, Sullivan, IN 5% Or Greater Direct Ownership Interest Jul 1, 1966 100%
Darin Sisil Individual Corporate DirectorBoard Member Nov 16, 2021 100%
Darin Greggs Individual Corporate Director Aug 1, 2017
Lori L Resler Individual Corporate DirectorChief Nursing Officer Feb 17, 2014 100%
Donald C Hunt Individual Corporate DirectorBoard Member Feb 14, 2014 100%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Family Practice Associates of Sullivan CountySullivan, IN, CCN 158540 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2019

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

Affiliated clinicians 228

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

View all 228

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1497759260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "address_2": "2200 N. SECTION STREET",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478820010",
            "telephone_number": "812-268-4311",
            "fax_number": "812-268-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 N SECTION ST",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478827523",
            "telephone_number": "812-268-4311",
            "fax_number": "812-268-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN COUNTY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "FRANKLIN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-268-4311",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IN",
            "license": "005013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, IN

Sources for this page

Verify at the official NPI Registry.