NPIMap

Organization Active NPI

Pulaski Memorial Hospital

Doing business as Majestic Care of Southport

  • Skilled Nursing Facility
  • Indianapolis, IN
National Provider Identifier
1669410593
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
05-000151-1 Issued in IN
Legal business name
PULASKI MEMORIAL HOSPITAL
Doing business as
Majestic Care of Southport
Practice address
8549 Madison Avenue
Indianapolis, IN 46227-6153
Phone
(317) 881-9164
Fax
(317) 887-4060
NPI assigned
Jun 3, 2006
Last updated
Mar 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Authorized official

Name
Mr. Gregg A. Malott
Title
Cfo
Phone
(574) 946-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 05-000151-1 IN Primary

Addresses

Primary practice location

8549 Madison Avenue
Indianapolis, IN 46227-6153

Mailing address

8549 Madison Avenue
Indianapolis, IN 46227-6153
Phone (317) 881-9164

Other identifiers 1

IdentifierTypeStateIssuer
100284060MedicaidIN

Other names 1

  • Majestic Care of Southport Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211119001168 IN Part A Provider - Skilled Nursing Facility 3173515509 Practice locations: Indianapolis, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669410593. Details of each certification follow.

Skilled nursing facility certification: CCN 155247

Legal name
PULASKI MEMORIAL HOSPITAL
Doing business as
MAJESTIC CARE OF SOUTHPORT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 29, 1985
Last certification
Oct 11, 2024
Beds
122
Ownership / control type
Corporation
Multi-facility organization
Majestic Care
Organization structure
GovernmentNon-profit
Enrollment address
8549 South Madison Avenue
Indianapolis, IN 46227-6153
Nursing home name
MAJESTIC CARE OF SOUTHPORT
Affiliated entity
MAJESTIC CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Majestic Care of SouthportCCN 155247 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 29, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12283.1 residents per day on average
Chain
Majestic Care22 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0681241Majestic Care of Southport8549 S Madison Ave, Indianapolis, IN 46227Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Cindy Parker MD43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

View all 42

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Gregg a Malott Individual Corporate OfficerCfo Jul 1, 2021 100%
Pulaski Memorial Hospital Organization, Winamac, IN Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2021 100%
Thomas F Barry Individual Corporate OfficerCeo Jul 1, 2021 100%
John Seib Individual Contracted Managing EmployeeFacility Administrator Jul 1, 2021 100%

All facility ownership & control disclosures 27

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

FacilityTypeRoleSince
Envive of River CityEvansville, IN, CCN 155520 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2014
Jul 1, 2014
Majestic Care of West AllenFort Wayne, IN, CCN 155322 Skilled nursing facility Operational/Managerial Control (100%) Jun 1, 2015
Parkview HavenFrancesville, IN, CCN 155746 Skilled nursing facility Operational/Managerial Control (100%) Sep 1, 2015
Kingston Health Center of Fort WayneFort Wayne, IN, CCN 155479 Skilled nursing facility Operational/Managerial Control (100%) Dec 16, 2025
Northern Lakes Nursing and Rehabilitation CenterAngola, IN, CCN 155449 Skilled nursing facility Operational/Managerial Control (100%) Oct 1, 2015
The Milton HomeSouth Bend, IN, CCN 155738 Skilled nursing facility Operational/Managerial Control (100%) Dec 1, 2016
Simmons Loving Care Health FacilityGary, IN, CCN 155845 Skilled nursing facility Operational/Managerial Control (100%) May 1, 2018
Maple Manor Christian HomeSellersburg, IN, CCN 155766 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2019
Saint AnthonyCrown Point, IN, CCN 155214 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020
Majestic Care of Jefferson PointeFort Wayne, IN, CCN 155446 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020
Majestic Care of AvonAvon, IN, CCN 155338 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020
Cardinal Care StrategiesMuncie, IN, CCN 155400 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 27, 2021
Majestic Care of CarmelCarmel, IN, CCN 155618 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Poplar Care StrategiesLoogootee, IN, CCN 155374 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Sycamore Care StrategiesLoogootee, IN, CCN 155263 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Gentle Care StrategiesVincennes, IN, CCN 155519 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Heritage CenterEvansville, IN, CCN 155104 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
Saint AnthonyWinamac, IN, CCN 155436 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2023
Hickory Creek at RochesterRochester, IN, CCN 155430 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2023
Briarcliff Health & Rehabilitation CenterSouth Bend, IN, CCN 155831 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 2024
South Shore Health & Rehabilitation CenterGary, IN, CCN 155530 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 2024
Asbury Towers Health Care CenterGreencastle, IN, CCN 155758 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2024
Jul 1, 2024
Pulaski Memorial HospitalWinamac, IN, CCN 158512 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 20, 2002
Mar 20, 2002
Pulaski Memorial Hospital Francesville Family MedicineFrancesville, IN, CCN 158528 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1989
Jan 1, 1989
Pulaski Memorial Hospital North Judson Family MedicineNorth Judson, IN, CCN 158527 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1989
Jan 1, 1989
Pulaski Memorial Hospital Knox Medical CenterKnox, IN, CCN 158554 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2019
Sep 1, 2019
Pulaski Memorial Hospital Culver Medical CenterCulver, IN, CCN 158581 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2024
Jan 1, 2024

Facilities with the same owner 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1669410593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8549 MADISON AVENUE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276153",
            "telephone_number": "317-881-9164",
            "fax_number": "317-887-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8549 MADISON AVENUE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276153",
            "telephone_number": "317-881-9164",
            "fax_number": "317-887-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "MALOTT",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-946-2100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "05-000151-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100284060",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Majestic Care of Southport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.