Lifespring, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Jeffersonville, IN
NPI 1700435948 · NPPES record last updated Sep 10, 2019
Key facts
- NPI
- 1700435948
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LIFESPRING, INC
- Practice address
- 460 Spring St
Jeffersonville, IN 47130-3452 - Phone
- (812) 280-2080
- NPI assigned
- Sep 10, 2019
- Organization subpart
- No
Authorized official
- Name
- Terry Stawar
- Title
- Ceo
- Phone
- (812) 206-1234
Owners & managing parties with NPI records 15
Owned or controlled facilities with NPI records 12
Other NPIs on the same Medicare enrollment 19
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 34
Facilities with the same owner 12
Practitioners 71
-
Anthony Aemmer II, APRN
-
Terri Dawn Backherms, L.C.S.W.
-
Chrstina M. Beeler, LCSW
-
Leigha Bowyer Jones, APN
-
Christopher Edlin, LMHCA
-
Michelle Emmons, LCSW
-
Lindasue Farrell, LCSW
-
Jackie Fischer, LCSW
-
Steven Fitts, LCSW
-
Patrick Flaherty, LCSW
-
Sarah Gill, PMHNP
-
Meara W Grannan, LCSW
-
Paul Hartman, LCSW
-
Joseph Higgins, LCSW
-
Alan Hightower, PA
-
Eric Jaggers, MD
-
Arese F James, LCSW
-
Emily Kennedy, LSW
-
Roberta Darlene Kilburn, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in IN
Federally qualified health center certification: CCN 151058
- Legal name
- LIFESPRING, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 18, 2019
- Last certification
- Sep 18, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 460 Spring St
Jeffersonville, IN 47130-3452
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Alan Smock |
Corporate Officer |
Jul 1, 2022 | |
| Jacalyn Young |
Corporate Officer |
Jul 1, 2022 | |
| Emily Stumler |
Corporate Officer | Jul 1, 2022 | |
| Paul Kiger |
Corporate Officer | Jul 1, 2022 | |
| Melissa Campbell |
Corporate Officer | Jul 1, 2022 | |
| Darnell Jackson |
Corporate Officer | Jul 1, 2022 | |
| Lifespring, Inc |
5% Or Greater Direct Ownership Interest | Apr 15, 1966 | 100% |
| Margo Olson |
Corporate Officer | May 1, 2023 | |
| Anne Beth Kenney |
Corporate Officer |
Jan 1, 2021 | |
| Corporate Director |
Jan 1, 2021 | ||
| W-2 Managing Employee |
Jan 1, 2021 | ||
| Operational/Managerial Control |
Jan 1, 2021 | ||
| Wendy Broughton |
Corporate Officer | Jul 1, 2022 | |
| Denise Eden |
Corporate Officer | Jul 1, 2022 | |
| Rossina Sandoval Monsivais |
Corporate Officer | Jul 1, 2022 | |
| Kenny Kavanaugh |
Corporate Officer | Jul 1, 2022 | |
| Kristie Swoboda |
Corporate Director |
Sep 1, 2024 | |
| W-2 Managing Employee |
Sep 1, 2024 | ||
| Ray Oppel |
Corporate Officer | Jul 1, 2022 |
All facility ownership & control disclosures 12
| Facility | Type | Role | Since |
|---|---|---|---|
| Lifespring Community Medical Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2015 |
| Salem Community Medical Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 15, 2016 |
| Lifespring Adult Integrated Medical Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2019 |
| Austin Medical Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 16, 1966 |
| New Albany Student Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2024 |
| Jasper Community Medical Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2024 |
| Metro Mobile Unit |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 16, 1966 |
| Dale Community Medical Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2024 |
| Lifespring Orleans Family Health |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 24, 2024 |
| Charlestown Community Medical Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 21, 2024 |
| Lifespring Forensics Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2024 |
| Floyd Central Student Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Nov 27, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040315000128 | IN | Part B Supplier - Clinic/Group Practice | 5294624508 |
Receives reassigned benefits from 66 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: New Albany, IN; Paoli, IN; Rockport, IN; Salem, IN; Scottsburg, IN; Tell City, IN; Jeffersonville, IN; Madison, IN… |
| O20040805000332 | IN | Part B Supplier - Clinic/Group Practice | 5294624508 |
Receives reassigned benefits from 115 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Dale, IN; Tell City, IN; Scottsburg, IN; Salem, IN; Rockport, IN; Paoli, IN; New Albany, IN; Madison, IN… |
| O20190918002103 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 5294624508 | Practice locations: Jeffersonville, IN |
National Provider Directory
- Tax ID family
- Lifespring Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
460 Spring St
Jeffersonville, IN 47130-3452
Mailing address
460 Spring St
Jeffersonville, IN 47130-3452
Phone (812) 280-2080
Other providers in Jeffersonville, IN
- Lifespring Medical Services, Inc
- Lifespring Pharmacy
- Lifespring, Inc
- Lifespring, Inc
- Lifespring, Inc
- Lifespring, Inc
- Lifespring, Inc
- Lifespring, Inc
- Lifespring, Inc
- Lifespring, Inc
All providers in Jeffersonville, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.