NPIMap

Organization Active NPI

Saint Thomas Dekalb Hospital, LLC

Doing business as Ascension Saint Thomas Dekalb

  • General Acute Care Hospital
  • Smithville, TN
National Provider Identifier
1649659582
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
SAINT THOMAS DEKALB HOSPITAL, LLC
Doing business as
Ascension Saint Thomas Dekalb
Practice address
520 W Main St
Smithville, TN 37166-1138
Phone
(615) 215-5000
NPI assigned
May 26, 2015
Last updated
Aug 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Authorized official

Name
Craig Polkow
Title
Authorized Official
Phone
(615) 284-7847

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

520 W Main St
Smithville, TN 37166-1138

Mailing address

102 Woodmont Blvd
Suite 800
Nashville, TN 37205-2287

Other names 1

  • Ascension Saint Thomas Dekalb Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151015000752 TN Part A Provider - Hospital 9436468329 Practice locations: Smithville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649659582. Details of each certification follow.

Hospital certification: CCN 440148

Legal name
SAINT THOMAS DEKALB HOSPITAL, LLC
Doing business as
ASCENSION SAINT THOMAS DEKALB
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Aug 5, 1969
Last certification
Apr 20, 2000
Beds
71
Ownership / control type
Church
Most recent change of ownership
Jun 30, 2006 (3 total)
Organization structure
LLCNon-profit
Incorporated
May 15, 2015 in TN
Enrollment address
520 West Main St
Smithville, TN 37166-1138
Other Hospital Practice Location
Hospital subgroups
General

Care Compare: Hospital

Medicare Care Compare
Listed as
Dekalb Community HospitalCCN 440148 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Brandon Williams Individual Corporate Officer Oct 31, 2022
Susan Conley Individual W-2 Managing EmployeeCeo Aug 1, 2015
Saint Thomas Regional Hospitals Organization, Nashville, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2015 100%
Raymond Randal Johnson Individual Corporate OfficerChief Administrative Officer Jul 1, 2021
W-2 Managing EmployeeChief Administrative Officer Jul 1, 2021
Saint Thomas Health Organization, Nashville, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2015 100%
Ascension Health Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2015 100%
Lisa Davis Individual Corporate DirectorBoard Member Aug 1, 2015

Owners & managing parties with NPI records 3

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

Facilities with the same owner 164

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

View all 164

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.

Affiliated clinicians 83

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

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1649659582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD",
            "address_2": "SUITE 800",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W MAIN ST",
            "city": "SMITHVILLE",
            "state": "TN",
            "postal_code": "371661138",
            "telephone_number": "615-215-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT THOMAS DEKALB HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-26",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "POLKOW",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-284-7847"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Saint Thomas Dekalb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smithville, TN

Sources for this page

Verify at the official NPI Registry.