NPIMap

Organization Active NPI

Southern Indiana Community Health Care, Inc

Doing business as Patoka Family Health Care

  • Federally Qualified Health Center (FQHC)
  • English, IN
National Provider Identifier
1629585591
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC
Doing business as
Patoka Family Health Care
Practice address
307 S Indiana Ave
English, IN 47118
Phone
(812) 338-2924
Fax
(812) 338-3706
NPI assigned
Jan 2, 2018
Last updated
Dec 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Authorized official

Name
Nancy Radcliff
Title
Ceo
Phone
(812) 723-7118

Specialties & licenses 1

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

Addresses

Primary practice location

307 S Indiana Ave
English, IN 47118

Mailing address

PO Box 270
Paoli, IN 47454-0270
Phone (812) 723-3944

Other identifiers 1

IdentifierTypeStateIssuer
200164670AMedicaidIN

Other names 1

  • Patoka Family Health Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180215001907 IN Part A Provider - Federally Qualified Health Center (FQHC) 5799694360 Practice locations: English, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629585591. Details of each certification follow.

Federally qualified health center certification: CCN 151016

Legal name
SOUTHERN INDIANA COMMUNITY HEALTH CARE INC
Doing business as
PATOKA FAMILY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 15, 2018
Last certification
Feb 15, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1975 in IN
Enrollment address
307 S Indiana Ave
English, IN 47118

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Comprehensive Health Care9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

2759 State Road 37
Mitchell, IN 47446
Phone (812) 849-6420

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Nancy Radcliff Individual Corporate OfficerCeo Jan 1, 2015 50%
Yolanda J Yoder Individual Corporate OfficerCmo Jan 1, 2022
Sue Brock Individual Corporate OfficerCfo Jul 23, 2016 50%
W-2 Managing EmployeeCfo Jul 23, 2016 100%
Evelyn Shellenberger Individual Corporate OfficerChair Jan 1, 2022
Ryan Engleking Individual Corporate OfficerVice Chair Jan 1, 2022
Carrie Rahman Individual Corporate OfficerTreasurer Jan 1, 2022
John Noblitt Individual Corporate OfficerBoard Member Jan 1, 2022
Floyd Chupp Individual Corporate OfficerBoard Member Jan 1, 2022
Nick Siler Individual Corporate OfficerBoard Member Jan 1, 2022
Carla McSpadden Individual Corporate OfficerSecretary Jan 1, 2022
Mindy Babbitt Individual Corporate OfficerBoard Member Jan 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1514851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1629585591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474540270",
            "telephone_number": "812-723-3944",
            "fax_number": "812-723-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S INDIANA AVE",
            "city": "ENGLISH",
            "state": "IN",
            "postal_code": "47118",
            "telephone_number": "812-338-2924",
            "fax_number": "812-338-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIANA COMMUNITY HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-02",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "RADCLIFF",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-723-7118"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200164670A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Patoka Family Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in English, IN

Sources for this page

Verify at the official NPI Registry.