NPIMap

Organization Active NPI

Deaconess Hospital, Inc

Doing business as Deaconess Family Medicine

  • Family Medicine Physician
  • Evansville, IN
National Provider Identifier
1578727475
Registry record updated Aug 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DEACONESS HOSPITAL, INC
Doing business as
Deaconess Family Medicine
Practice address
415 W Columbia St
Ste 100
Evansville, IN 47710-1656
Phone
(812) 450-6200
Fax
(812) 450-6202
NPI assigned
Jul 10, 2008
Last updated
Aug 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2017

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

Authorized official

Name
Cheryl A Wathen
Title
Cfo
Phone
(812) 450-3296

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Family Nurse Practitioner 363LF0000X NU
Psychologist 103T00000X NU
Family Medicine Physician 207Q00000X NU Primary
Obstetrics & Gynecology Physician 207V00000X NU

Addresses

Primary practice location

415 W Columbia St
Ste 100
Evansville, IN 47710-1656

Mailing address

PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-6200

Other identifiers 1

IdentifierTypeStateIssuer
100241900MedicaidIN

Other names 1

  • Deaconess Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000129 IN Part B Supplier - Clinic/Group Practice 9032021431 Receives reassigned benefits from 719 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evansville, IN; Newburgh, IN

Other NPIs on the same Medicare enrollment 43

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

View all 43

National Provider Directory

National Provider Directory
Tax ID family
John C Betancourt MD46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

Locations

415 W Columbia St
Ste 100
Evansville, IN 47710
Phone (812) 450-3363

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503273600000",
    "number": "1578727475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3407",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477333407",
            "telephone_number": "812-450-6200",
            "fax_number": "812-450-6202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W COLUMBIA ST",
            "address_2": "STE 100",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101656",
            "telephone_number": "812-450-6200",
            "fax_number": "812-450-6202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2017-08-21",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100241900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; 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.

Verify at the official NPI Registry.