NPIMap

Organization Active NPI

St. Vincent Randolph Hospital, Inc.

Doing business as Ascension St. Vincent Randolph

  • Critical Access Hospital
  • Winchester, IN
National Provider Identifier
1609826783
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
050050501 Issued in IN
Legal business name
ST. VINCENT RANDOLPH HOSPITAL, INC.
Doing business as
Ascension St. Vincent Randolph
Practice address
473 E Greenville Ave
Winchester, IN 47394-9436
Phone
(765) 584-0004
NPI assigned
May 11, 2006
Last updated
Aug 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

Name
Ms. Kathy Young
Title
Interim Administrator
Phone
(765) 584-0107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 050050501 IN Primary

Addresses

Primary practice location

473 E Greenville Ave
Winchester, IN 47394-9436

Mailing address

473 E Greenville Ave
Winchester, IN 47394-9436
Phone (765) 584-0004

Other identifiers 2

IdentifierTypeStateIssuer
200321460AMedicaidIN
200307450MedicaidIN

Other names 1

  • Ascension St. Vincent Randolph Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090706000291 IN Part A Provider - Critical Access Hospital 3274443882 Practice locations: Winchester, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609826783. Details of each certification follow.

Hospital certification: CCN 151301

Legal name
ST VINCENT RANDOLPH HOSPITAL INC
Doing business as
ASCENSION ST. VINCENT RANDOLPH
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 9, 1999
Last certification
Oct 13, 2011
Beds
25
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jun 30, 2000 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 2000 in IN
Enrollment address
473 E Greenville Ave
Winchester, IN 47394-9436

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St Vincent RandolphCCN 151301 · 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
St Vincent Physician Network LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jacob Steve Baker Individual Corporate DirectorBoard Member Jul 1, 2023
Kevin P Speer Individual Corporate OfficerHome Office - President & Ceo May 1, 2023
Cynthia Dawn Adams Individual Corporate DirectorBoard Memeber Nov 30, 2017
Carlyle Floyd Individual Corporate DirectorBoard Member Jul 1, 2023
Floyd Grubb Individual Corporate DirectorBoard Member Jul 1, 2023
Michael Todd Emmons Individual Corporate DirectorBoard Member Jul 1, 2023
St Vincent Randolph Hospital Inc Organization, Winchester, IN Non-profit 5% Or Greater Direct Ownership Interest Feb 29, 2000 100%
Dana M Muntz Individual Corporate OfficerVP of Rural Healthcare Jul 1, 2023
Corporate DirectorBoard Member Jul 1, 2023
W-2 Managing EmployeeVP of Rural Healthcare Jul 1, 2023
Brian Edwards Individual Corporate DirectorBoard Member Jul 1, 2012
Ascension Health Organization, Saint Louis, MO Non-profit Operational/Managerial Control Jun 30, 2000
St Vincent Health Inc Organization, Indianapolis, IN Non-profit Operational/Managerial Control Jun 30, 2000
Ryan Penrod Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ascension St. Vincent RandolphWinchester, IN, CCN 15Z301 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 29, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 166

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

View all 166

Practitioners & affiliated clinicians

Affiliated clinicians 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1609826783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 E GREENVILLE AVE",
            "city": "WINCHESTER",
            "state": "IN",
            "postal_code": "473949436",
            "telephone_number": "765-584-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 E GREENVILLE AVE",
            "city": "WINCHESTER",
            "state": "IN",
            "postal_code": "473949436",
            "telephone_number": "765-584-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT RANDOLPH HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "INTERIM ADMINISTRATOR",
        "authorized_official_telephone_number": "765-584-0107",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IN",
            "license": "050050501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200321460A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200307450",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent Randolph",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winchester, IN

Sources for this page

Verify at the official NPI Registry.