NPIMap

Organization Active NPI

Community Hospital of Bremen, Inc

  • Critical Access Hospital
  • Bremen, IN
National Provider Identifier
1568417004
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
05-005097-2 Issued in IN
Legal business name
COMMUNITY HOSPITAL OF BREMEN, INC
Practice address
1020 High Road
Bremen, IN 46506
Phone
(574) 546-2211
Fax
(574) 546-4312
NPI assigned
May 23, 2006
Last updated
Dec 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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

Authorized official

Name
Irene Maffetone
Title
Contracting Specialist
Phone
(574) 647-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 05-005097-2 IN Primary

Addresses

Primary practice location

1020 High Road
Bremen, IN 46506

Mailing address

1020 High Road
P.O. Box 8
Bremen, IN 46506
Phone (574) 546-2211

Other identifiers 1

IdentifierTypeStateIssuer
100269320AMedicaidIN

Other names 1

  • Community Hospital of Bremen Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000456 IN Part A Provider - Critical Access Hospital 6002897451 Practice locations: Bremen, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568417004. Details of each certification follow.

Hospital certification: CCN 151300

Legal name
COMMUNITY HOSPITAL OF BREMEN INC
Doing business as
COMMUNITY HOSPITAL OF BREMEN INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 5, 1999
Last certification
Jul 1, 2021
Beds
24
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 26, 1948 in IN
Enrollment address
1020 High Rd
Box 8
Bremen, IN 46506-1093

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Hospital of Bremen IncCCN 151300 · All quality measures
Type
Critical Access 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
Communityhosp Bremen4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1020 High Rd
#8
Bremen, IN 46506
Phone (574) 546-2211

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Andrew Wolf Individual Corporate DirectorMember Board of Directors Jun 1, 2012
Irene Maffetone Individual W-2 Managing Employee Jun 14, 2018
Norma Napoli Individual Corporate DirectorMember Board of Directors Jun 1, 2007
Beacon Health System Inc Organization, South Bend, IN Corporation 5% Or Greater Indirect Ownership Interest Jun 14, 2018 100%
Carol Hochstetler Individual Corporate OfficerChairman Board of the Directors Jun 1, 2012
Jeffrey P Costello Individual Corporate OfficerCfo Jun 14, 2018 100%
Amy Lashbrook Individual Corporate OfficerVP of Finance/Cfo Aug 18, 2014
W-2 Managing EmployeeVP of Finance/Cfo Aug 18, 2014
David Bailey Individual Corporate Officer Mar 18, 2013
W-2 Managing EmployeePresident/Ceo Mar 18, 2013
Karen Shorter Individual Corporate DirectorMember Board of Directors Jun 1, 2009
Thomas Teghtmeyer Individual Corporate OfficerVice Chairman Board of the Direc Jun 1, 2012
Jeff Brinkman Individual Corporate OfficerSecretary Board of Directors Jun 1, 2012
James Richardson Individual Corporate DirectorMember Board of Directors Jun 1, 2012
William Davis Individual Corporate OfficerTreasurer-Board of Directors Jun 1, 2012
Alan Miller Individual Corporate DirectorMember Board of Directors Jun 1, 2009

Facilities with the same owner 21

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

View all 21

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 192

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

View all 192

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1568417004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 HIGH ROAD",
            "address_2": "P.O. BOX 8",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "46506",
            "telephone_number": "574-546-2211",
            "fax_number": "574-546-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 HIGH ROAD",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "46506",
            "telephone_number": "574-546-2211",
            "fax_number": "574-546-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL OF BREMEN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "MAFFETONE",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "CONTRACTING SPECIALIST",
        "authorized_official_telephone_number": "574-647-1040"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IN",
            "license": "05-005097-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100269320A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Hospital of Bremen",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Community Hospital of Bremen",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bremen, IN

Sources for this page

Verify at the official NPI Registry.