NPIMap

Organization Active NPI

Indiana Regional Medical Center

  • Rural Acute Care Hospital
  • Indiana, PA
National Provider Identifier
1508047630
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
090701 Issued in PA
Legal business name
INDIANA REGIONAL MEDICAL CENTER
Practice address
1265 Wayne Ave BLDG Suite201
Center for Wound Healing
Indiana, PA 15701-3501
Phone
(724) 357-7008
Fax
(724) 357-7414
NPI assigned
Nov 16, 2007
Last updated
Jul 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Mr. Michael F Ickowski, CPA, MBA
Title
Chief Financial Officer
Phone
(724) 357-7008

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Acute Care Hospital 282NR1301X 090701 PA Primary

Addresses

Primary practice location

1265 Wayne Ave BLDG Suite201
Center for Wound Healing
Indiana, PA 15701-3501

Mailing address

PO Box 788
835 Hospital Road
Indiana, PA 15701-0788
Phone (724) 357-7008

Other identifiers 2

IdentifierTypeStateIssuer
000068OtherPAHIGHMARK
1007713530032MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081216000245 PA Part A Provider - Hospital 6800791187 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indiana, PA; Seward, PA; Northern Cambria, PA; Marion Center, PA; Ligonier, PA; Greensburg, PA; Blairsville, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508047630. Details of each certification follow.

Hospital certification: CCN 390173

Legal name
INDIANA REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 12, 2021
Beds
166
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 16, 1913 in PA
Enrollment address
145 Irmc Dr
Indiana, PA 15701-3673
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Indiana Regional Medical CenterCCN 390173 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Pathology Indiana Hosp15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 26

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 Martin Individual Corporate DirectorTreasurer Nov 1, 2020
Christina Lubold Individual Corporate DirectorBoard Member Jan 1, 2022
Mary Krauland Individual Corporate DirectorBoard Member Jul 1, 2024
James Kinneer Individual W-2 Managing EmployeeChief Human Resources Officer Nov 28, 2017 14.28%
Nathan Kovalchick Individual Corporate OfficerChairman Jan 1, 2022
Wendell S Davis Individual Corporate DirectorBoard Member Jul 1, 2024
Pennsylvania Mountains Care Network Organization, Indiana, PA Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2020 100%
Operational/Managerial Control Nov 1, 2020 100%
Laurie Kuzneski Individual Corporate DirectorVice Chairman Jan 1, 2020
Michael F Ickowski Sr Individual W-2 Managing EmployeeChief Financial Officer Jun 26, 2023 14.28%
Mark Richards Individual W-2 Managing EmployeeChief Growth Officer Nov 28, 2017 14.28%
Operational/Managerial ControlIndiana Regional Medical Center Nov 28, 2017 5%
April L Miller Individual W-2 Managing EmployeeExc Director Revenue Cycle Apr 8, 2024
Sandra Luttner Individual Operational/Managerial ControlController Nov 2, 2009
T Clark Simpson Individual Corporate DirectorBoard Member Nov 1, 2020
Frank Roberts Individual Corporate OfficerSecretary Nov 1, 2020
Todd Brice Individual Corporate DirectorBoard Member Nov 1, 2020
Mark Volovic Individual W-2 Managing EmployeeChief Information Officer May 1, 2017 14.28%
Rebecca Stapleton Individual Corporate DirectorBoard Member Nov 1, 2017 5%
Wendy Haislip Individual W-2 Managing EmployeeChief Nursing Officer Oct 21, 2019 14.28%
Richard K Neff Individual W-2 Managing EmployeeChief Medical Officer Oct 26, 2020 14.28%
Chad R Shaffer Individual Corporate DirectorBoard Member Jul 1, 2024
Hilliary Creely Individual Corporate DirectorBoard Member Nov 1, 2020
Stephen a Wolfe Individual Corporate DirectorChief Executive Officer Feb 11, 1999
W-2 Managing EmployeeChief Executive Officer Feb 11, 1999 14.28%
Kyle a Lingenfelter Individual Corporate DirectorBoard Member Jan 1, 2026
T Michael Price Individual Corporate OfficerBoard Member Nov 1, 2020
Russell a Drozdiak Individual Corporate DirectorBoard Member Nov 1, 2020
David Reed Individual Corporate DirectorBoard Member Jan 1, 2026

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 352

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

View all 352

NPI Registry JSON

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1508047630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "address_2": "835 HOSPITAL ROAD",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157010788",
            "telephone_number": "724-357-7008",
            "fax_number": "724-357-7414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 WAYNE AVE BLDG SUITE201",
            "address_2": "CENTER FOR WOUND HEALING",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013501",
            "telephone_number": "724-357-7008",
            "fax_number": "724-357-7414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "ICKOWSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "724-357-7008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA, MBA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "PA",
            "license": "090701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "000068",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007713530032",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

Verify at the official NPI Registry.