Active NPI
Good Samaritan Hospital
- Family Nurse Practitioner
- Vincennes, IN
National Provider Identifier
1538508676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- GOOD SAMARITAN HOSPITAL
- Practice address
- 429 S 6TH St
Vincennes, IN 47591-1022 - Phone
- (812) 885-3703
- Fax
- (812) 885-3707
- NPI assigned
- Jun 21, 2013
- Organization subpart
- Yes
- Parent organization
- MEDICAL HOME
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert D McLin
- Title
- Ceo
- Phone
- (812) 885-3333
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Internal Medicine Physician | 207R00000X | |||
| Nurse Practitioner | 363L00000X | |||
| Acute Care Nurse Practitioner | 363LA2100X | |||
| Adult Health Nurse Practitioner | 363LA2200X | |||
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
429 S 6TH St
Vincennes, IN 47591-1022
Mailing address
520 S 7TH St
Vincennes, IN 47591-1038
Phone (812) 882-5220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100270150 | Medicaid | IN |
Other names 1
- Medical Home
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031204000723 | IN | Part B Supplier - Clinic/Group Practice | 9436061918 |
Receives reassigned benefits from 12 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Vincennes, IN |
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community Health Registered Nurse
- Vincennes, IN
- NPI 1033578273
O20031204000723
-
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Vincennes, IN
- NPI 1073153474
O20031204000723
-
- Community/Behavioral Health Agency
- Vincennes, IN
- NPI 1861490435
O20031204000723
-
- Community/Behavioral Health Agency
- Petersburg, IN
- NPI 1952309528
O20031204000723
-
- Nurse Practitioner
- Vincennes, IN
- NPI 1336576875
O20031204000723
National Provider Directory
National Provider Directory- Part of
- Good Samaritan Hosp
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371772800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1447286400000",
"number": "1538508676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 S 7TH ST",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475911038",
"telephone_number": "812-882-5220",
"fax_number": "812-885-3737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "429 S 6TH ST",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475911022",
"telephone_number": "812-885-3703",
"fax_number": "812-885-3707"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOOD SAMARITAN HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MEDICAL HOME",
"enumeration_date": "2013-06-21",
"last_updated": "2015-11-12",
"status": "A",
"authorized_official_last_name": "MCLIN",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "812-885-3333"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"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
},
{
"code": "363LA2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Adult Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100270150",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Medical Home",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Vincennes, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; 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.