Active NPI
Whitley Memorial Hospital, Inc.
- Land Ambulance
- Columbia City, IN
National Provider Identifier
1497764450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 0091
- Legal business name
- WHITLEY MEMORIAL HOSPITAL, INC.
- Practice address
- 1250 E State Road 205
Columbia City, IN 46725 - Phone
- (260) 248-9302
- Fax
- (260) 248-9107
- NPI assigned
- Aug 7, 2006
- Organization subpart
- Yes
- Parent organization
- WHITLEY MEMORIAL HOSPITAL, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stanton Risser
- Title
- Acfo
- Phone
- (260) 266-9380
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 0091 | IN | Primary |
Addresses
Primary practice location
1250 E State Road 205
Columbia City, IN 46725
Mailing address
PO Box 5600
Fort Wayne, IN 46895-5600
Phone (260) 373-7008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100453960A | Medicaid | IN |
Other names 1
- Parkview Whitley Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051109000024 | IN | Part A Provider - Hospital | 0446278469 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Columbia City, IN; Warsaw, IN |
Hospital certification: CCN 150101
- Legal name
- WHITLEY MEMORIAL HOSPITAL INC
- Doing business as
- PARKVIEW WHITLEY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Oct 29, 2016
- Beds
- 30
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation
- Enrollment address
- 1260 E State Road 205
Columbia City, IN 46725-9492 - Hospital subgroups
- Acute care
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- General Acute Care Hospital
- Columbia City, IN
- NPI 1205844495
O20051109000024
Care Compare: Hospital
Medicare Care Compare- Listed as
- Parkview Whitley Hospital
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Tax ID family
- Whitley Memorial Hospit
- Part of
- Whitley Memorial Hospit
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Acute Care Hospital
- Warsaw, IN
- NPI 1497537369
-
- General Acute Care Hospital
- Columbia City, IN
- NPI 1205844495
Locations
1250 E State Road 205
Columbia City, IN 46725
Phone (260) 248-9302
Ownership & related parties
All disclosed owners & managing parties 18
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| James Heuer | Other | Jan 1, 2015 | |
| Parkview Health System Inc | 5% Or Greater Direct Ownership Interest | Jun 28, 1995 | 100% |
| Cindy Baker | Other | Jan 1, 2024 | |
| Jessica Lee-Hansen | Corporate Officer | Jan 1, 2026 | |
| W-2 Managing Employee | Jan 1, 2026 | ||
| Svetlana V Hagan | Other | Jan 1, 2023 | |
| DJ Sigler | Other | Jan 1, 2023 | |
| Torrey Bauer | Other | Jan 1, 2024 | |
| Alan Grossnickle | Other | Jan 1, 2024 | |
| David E Reinhard | Corporate Officer | Jan 1, 2026 | |
| Richard Haddad | Other | Jan 1, 2024 | |
| Robin Wright | Other | Jan 1, 2024 | |
| Scott Gabriel | W-2 Managing Employee | Jun 27, 2010 | |
| Rick Henvey | Corporate Officer | Jan 1, 2022 | |
| Christopher McKeand | Corporate Officer | Jan 1, 2026 | |
| Angela Gakstatter-Tom | Other | Jan 1, 2024 | |
| Scott Wiley | Corporate Officer | Jan 1, 2026 | |
| Mark Johnson | Other | Jan 1, 2023 | |
| Stanton Risser | Corporate Officer | Jul 28, 2024 | |
| W-2 Managing Employee | Jul 28, 2024 |
Owners & managing parties with NPI records 4
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Fort Wayne, IN
- NPI 1932130952
5% Or Greater Direct Ownership Interest
-
- Cardiovascular Disease Physician
- Fort Wayne, IN
- NPI 1447585153
5% Or Greater Direct Ownership Interest
Practitioners & affiliated clinicians
Affiliated clinicians 626
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Anatomic Pathology & Clinical Pathology Physician
- Fort Wayne, IN
- NPI 1194302398
Hospital
-
- Cardiovascular Disease Physician
- Indianapolis, IN
- NPI 1891766309
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1730332800000",
"number": "1497764450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5600",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468955600",
"telephone_number": "260-373-7008",
"fax_number": "260-373-7059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 E STATE ROAD 205",
"city": "COLUMBIA CITY",
"state": "IN",
"postal_code": "46725",
"telephone_number": "260-248-9302",
"fax_number": "260-248-9107"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WHITLEY MEMORIAL HOSPITAL, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WHITLEY MEMORIAL HOSPITAL, INC.",
"enumeration_date": "2006-08-07",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A",
"authorized_official_last_name": "RISSER",
"authorized_official_first_name": "STANTON",
"authorized_official_title_or_position": "ACFO",
"authorized_official_telephone_number": "260-266-9380"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "IN",
"license": "0091",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100453960A",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Parkview Whitley Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Parkview Whitley Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Columbia City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.