Deaconess Memorial Medical Center Inc
Organization Active NPI Nephrology Physician · Jasper, IN
NPI 1598088064 · NPPES record last updated Aug 27, 2025
Key facts
- NPI
- 1598088064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- Legal business name
- DEACONESS MEMORIAL MEDICAL CENTER INC
- Practice address
- 721 W 13TH St
Suite 225
Jasper, IN 47546-1855 - Phone
- (812) 996-7388
- Fax
- (812) 996-0150
- NPI assigned
- Mar 11, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- DEACONESS MEMORIAL MEDICAL CENTER INC
Authorized official
- Name
- Keith Miller
- Title
- Cao & Indiana Region President
- Phone
- (812) 996-0507
Other NPIs on the same Medicare enrollment 36
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031118000733 | IN | Part B Supplier - Clinic/Group Practice | 4587578042 |
Receives reassigned benefits from 170 practitioners 36 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jasper, IN; Shoals, IN; Loogootee, IN; Montgomery, IN; Petersburg, IN; Santa Claus, IN; Washington, IN; Dale, IN… |
National Provider Directory
- Part of
- Little Company Hosp in Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | Yes |
Addresses
Primary practice location
721 W 13TH St
Suite 225
Jasper, IN 47546-1855
Mailing address
800 W 9TH St
Jasper, IN 47546-2514
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200048850Y | Medicaid | IN |
Other names
- Memorial Hospital and Health Care Center
Other providers in Jasper, IN
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Memorial Medical Center Inc
All providers in Jasper, IN · Nephrology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.