NPIMap

Organization Active NPI

Witham Memorial Hospital

Doing business as Witham Health Services

  • General Acute Care Hospital
  • Lebanon, IN
National Provider Identifier
1699757401
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
WITHAM MEMORIAL HOSPITAL
Doing business as
Witham Health Services
Practice address
2605 N Lebanon St
Lebanon, IN 46052-1476
Phone
(765) 485-8000
Fax
(765) 485-8118
NPI assigned
Nov 17, 2005
Last updated
Jul 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Authorized official

Name
Kelly Braverman
Title
Ceo, President
Phone
(765) 485-8100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary
Durable Medical Equipment & Medical Supplies 332B00000X NU

Addresses

Primary practice location

2605 N Lebanon St
Lebanon, IN 46052-1476

Mailing address

2605 N Lebanon St
Lebanon, IN 46052-1476

Other identifiers 3

IdentifierTypeStateIssuer
100469070AMedicaidIN
300039905MedicaidIN
100269130AMedicaidIN

Other names 1

  • Witham Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030402000028 IN Part A Provider - Hospital 4082523170 Practice locations: Lebanon, IN; Zionsville, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699757401. Details of each certification follow.

Hospital certification: CCN 150104

Legal name
WITHAM MEMORIAL HOSPITAL
Doing business as
WITHAM HEALTH SERVICES
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 13, 2003
Beds
52
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
2605 N Lebanon St
Lebanon, IN 46052-1476
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Witham Health ServicesCCN 150104 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
James Anthony Boudreau37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Kelly Braverman Individual Corporate OfficerPresident/Ceo Dec 1, 2021 100%
W-2 Managing EmployeePresident/Ceo Dec 1, 2021 100%
Witham Memorial Hospital Organization, Lebanon, IN Non-profit Operational/Managerial Control Nov 24, 2011 100%
Daniel E Sellers Individual Corporate OfficerCfo Jun 21, 2024 100%
Michael Jason Hornbecker Individual Corporate DirectorBoard Trustee Jan 1, 2024
Andrea Castetter Individual Corporate DirectorBoard Trustee Jan 1, 2023
Claude a Hawkins Individual Corporate DirectorBoard Trustee Sep 1, 2013
John W Brand Individual Corporate DirectorBoard Trustee Jan 1, 2015
Brett Bayston Individual Corporate DirectorBoard Trustee Jan 1, 2023

All facility ownership & control disclosures 31

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

FacilityTypeRoleSince
Ambassador HealthcareCenterville, IN, CCN 155490 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2011
Vermillion Convalescent CenterClinton, IN, CCN 155124 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Twin City HealthcareGas City, IN, CCN 155232 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Westridge Health Care CenterTerre Haute, IN, CCN 155234 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Persimmon Ridge Rehabilitation CentrePortland, IN, CCN 155526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Grand Valley Health & RehabMartinsville, IN, CCN 155605 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Willow Crossing Health & Rehabilitation CenterColumbus, IN, CCN 155535 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2011
Pineknoll Rehabilitation CentreWinchester, IN, CCN 155527 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2011
Camelot Care CenterLogansport, IN, CCN 155385 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2012
Alexandria Care CenterAlexandria, IN, CCN 155521 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2012
White Oak Health CampusMonticello, IN, CCN 155782 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
St Mary Healthcare CenterLafayette, IN, CCN 155094 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Waterford Place Health CampusKokomo, IN, CCN 155678 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Cumberland Pointe Health CampusWest Lafayette, IN, CCN 155775 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Blair Ridge Health CampusPeru, IN, CCN 155791 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Woodbridge Health CampusLogansport, IN, CCN 155724 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Greenleaf Health CampusElkhart, IN, CCN 155783 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
St Elizabeth Healthcare CenterDelphi, IN, CCN 155290 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Homewood Health CampusLebanon, IN, CCN 155680 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2015
Arlington Place Health CampusIndianapolis, IN, CCN 155816 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Wellbrooke of WabashWabash, IN, CCN 155806 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Wellbrooke of KokomoKokomo, IN, CCN 155819 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
The Villages at Historic SilvercrestNew Albany, IN, CCN 155813 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
The Springs at LafayetteLafayette, IN, CCN 155829 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Wellbrooke of CarmelCarmel, IN, CCN 155833 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
Clearvista Lake Health CampusIndianapolis, IN, CCN 155815 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2015
McGivney Health Care CenterCarmel, IN, CCN 155855 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015
Brooke Knoll VillageAvon, IN, CCN 155814 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2021
Westminster Village KentuckianaClarksville, IN, CCN 155191 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2023
Suburban Home Health, LLCNoblesville, IN, CCN 157092 Home health agency 5% Or Greater Indirect Ownership Interest (10.27%) Sep 3, 2024
Suburban HospiceNoblesville, IN, CCN 151547 Hospice 5% Or Greater Indirect Ownership Interest (10.27%) Nov 1, 2024

Facilities with the same owner 31

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

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 274

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

View all 274

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1699757401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476",
            "telephone_number": "765-485-8000",
            "fax_number": "765-485-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITHAM MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A",
        "authorized_official_last_name": "BRAVERMAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO, PRESIDENT",
        "authorized_official_telephone_number": "765-485-8100"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100469070A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300039905",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100269130A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Witham Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, IN

Sources for this page

Verify at the official NPI Registry.