NPIMap

Organization Active NPI

Good Samaritan Family Health Center, Inc

Doing business as Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Bicknell, IN
National Provider Identifier
1609646843
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Doing business as
Family Health Center
Practice address
215 E 4TH St FL 1
Bicknell, IN 47512-1803
Phone
(812) 885-2720
Fax
(812) 885-2723
NPI assigned
Jan 8, 2024
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SAMARITAN FAMILY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Jennifer Emmons
Title
Ceo
Phone
(812) 494-9501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

215 E 4TH St FL 1
Bicknell, IN 47512-1803

Mailing address

PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501

Other names 1

  • Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240813000376 IN Part A Provider - Federally Qualified Health Center (FQHC) 5294099321 Practice locations: Bicknell, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609646843. Details of each certification follow.

Federally qualified health center certification: CCN C51048

Legal name
GOOD SAMARITAN FAMILY HEALTH CENTER INC
Doing business as
FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 30, 2024
Last certification
Jul 30, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 25, 2017 in IN
Enrollment address
215 E 4TH St
FL 1
Bicknell, IN 47512-1803

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Family Health Center Inc31 organizations share this tax ID, including this one
Part of
Good Samaritan Family Health Center Inc

Other organizations with this tax ID 30

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

View all 30

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Stanley Graber Individual Corporate OfficerCfo Apr 27, 2023
Bridgett Bilskie Individual W-2 Managing EmployeePayor Contract Manager Apr 27, 2023
Kolby Kerzan Individual OtherChairman Sep 1, 2023
Jennifer Emmons Individual 5% Or Greater Direct Ownership InterestCeo Apr 27, 2023 100%
Traci French Individual Corporate OfficerCao Apr 1, 2024

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1609646843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 556",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475910556",
            "telephone_number": "812-494-9501",
            "fax_number": "812-494-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 4TH ST FL 1",
            "city": "BICKNELL",
            "state": "IN",
            "postal_code": "475121803",
            "telephone_number": "812-885-2720",
            "fax_number": "812-885-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "EMMONS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-494-9501"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bicknell, IN

Sources for this page

Verify at the official NPI Registry.