NPIMap

Organization Active NPI

State of Indiana, Auditor of State

Doing business as Madison State Hospital

  • Psychiatric Hospital
  • Madison, IN
National Provider Identifier
1700876224
Registry record updated Feb 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
STATE OWNED Issued in IN
Legal business name
STATE OF INDIANA, AUDITOR OF STATE
Doing business as
Madison State Hospital
Practice address
711 Green Rd
Madison, IN 47250-2143
Phone
(812) 265-2611
NPI assigned
Oct 26, 2005
Last updated
Feb 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2010

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

Authorized official

Name
Dr. Peggy S Stephens, M.D.NPI 1699765115
Title
Superintendent Medical Director
Phone
(812) 265-2611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X STATE OWNED IN Primary

Addresses

Primary practice location

711 Green Rd
Madison, IN 47250-2143

Mailing address

711 Green Rd
Madison, IN 47250-2143
Phone (812) 265-2611

Other identifiers 1

IdentifierTypeStateIssuer
100273320AMedicaidIN

Other names 1

  • MADISON STATE HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000564 IN Part B Supplier - Clinic/Group Practice 1759280118 Receives reassigned benefits from 113 practitioners
6 other NPIs on this enrollment
Practice locations: Evansville, IN; Indianapolis, IN; Logansport, IN; Madison, IN; Richmond, IN; West Lafayette, IN
O20110105000490 IN Part A Provider - Hospital 1759280118 Practice locations: Madison, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700876224. Details of each certification follow.

Hospital certification: CCN 154019

Legal name
STATE OF INDIANA AUDITOR OF STATE
Doing business as
MADISON STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 15, 1981
Last certification
May 20, 2009
Beds
332 (150 certified)
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
711 Green Rd
Madison, IN 47250-2143
Main/Primary Hospital Location
Hospital subgroups
Other

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Madison State HospitalCCN 154019 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jeffrey Wedding Individual Corporate DirectorDirector of Operations Oct 4, 2021
W-2 Managing EmployeeDirector of Operations Oct 4, 2021
State of Indiana Auditor of State Organization, Madison, IN 5% Or Greater Direct Ownership Interest Nov 1, 2010 100%
Katrina Norris Individual W-2 Managing EmployeeDeputy Director Feb 25, 2019

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Neurodiagnostic InstituteIndianapolis, IN, CCN 154008 Hospital Operational/Managerial Control (100%) Sep 16, 2015
Evansville State HospitalEvansville, IN, CCN 154056 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 22, 2010
Richmond State HospitalRichmond, IN, CCN 154018 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Indiana Veterans HomeWest Lafayette, IN, CCN 155787 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 21, 2011

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 123

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.

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1700876224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 GREEN RD",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472502143",
            "telephone_number": "812-265-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 GREEN RD",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472502143",
            "telephone_number": "812-265-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF INDIANA, AUDITOR OF STATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2010-02-02",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SUPERINTENDENT MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "812-265-2611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "IN",
            "license": "STATE OWNED",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100273320A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON STATE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, IN

Sources for this page

Verify at the official NPI Registry.