NPIMap

Organization Active NPI

St. Vincent Williamsport Hospital

  • Critical Access Hospital Clinic/Center
  • Veedersburg, IN
National Provider Identifier
1730136458
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
License
050050921 Issued in IN
Legal business name
ST. VINCENT WILLIAMSPORT HOSPITAL
Practice address
440 W Songer LN
Veedersburg, IN 47987-8547
Phone
(765) 294-2486
NPI assigned
May 28, 2006
Organization subpart
Yes
Parent organization
ST. VINCENT WILLIAMSPORT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Trina Marlatt, RN, MSN
Title
Administrator
Phone
(765) 762-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 050050921 IN Primary

Addresses

Primary practice location

440 W Songer LN
Veedersburg, IN 47987-8547

Mailing address

440 W Songer LN
Veedersburg, IN 47987-8547
Phone (765) 294-2486

Other identifiers 1

IdentifierTypeStateIssuer
200307100BMedicaidIN

Other names 2

  • Ascension St. Vincent Williamsport Doing business as
  • St. Vincent South Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040601001558 IN Part B Supplier - Clinic/Group Practice 4486636776 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Crawfordsville, IN; Frankfort, IN; Veedersburg, IN; Williamsport, IN
O20080428000024 IN Part A Provider - Rural Health Clinic 4486636776 Practice locations: Veedersburg, IN

Rural health clinic certification: CCN 153994

Legal name
ST VINCENT WILLIAMSPORT HOSPITAL
Doing business as
ASCENSION ST. VINCENT WILLIAMSPORT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 6, 2001
Last certification
Aug 24, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 8, 1944 in IN
Enrollment address
440 W Songer LN
Veedersburg, IN 47987-8547
Related CCNs
151307

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Williamsport Medical CL7 organizations share this tax ID, including this one
Part of
Williamsport Medical CL

Other organizations with this tax ID 6

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

Locations

1684 Bush Ln
Crawfordsville, IN 47933
Phone (765) 365-9500

440 W Songer Ln
Veedersburg, IN 47987
Phone (765) 294-2486

23 Fall St
Williamsport, IN 47993

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jacob Steve Baker Individual Corporate DirectorBoard Member Jul 1, 2024
Cynthia Dawn Adams Individual Corporate DirectorBoard Member Jul 1, 2024
Carlyle Floyd Individual Corporate DirectorBoard Member Jul 1, 2024
Floyd Grubb Individual Corporate DirectorBoard Member Jul 1, 2013
Michael Todd Emmons Individual Corporate DirectorBoard Member Jul 1, 2024
Dana M Muntz Individual Corporate OfficerCoo May 1, 2022
W-2 Managing Employee May 1, 2022
Allison Taylor Individual Corporate DirectorBoard Member Jul 1, 2024
Robin Ludlow Individual Corporate DirectorBoard Member Jul 1, 2024
Loraine Brown Individual Corporate DirectorBoard Member Jul 1, 2024
Ascension Health Organization, Saint Louis, MO Non-profit Operational/Managerial Control Oct 17, 2003
St Vincent Health Inc Organization, Indianapolis, IN Non-profit, Chain home office Operational/Managerial Control Nov 21, 2014 100%
Ryan Penrod Individual Corporate DirectorBoard Member Jul 1, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Ascension St. Vincent WilliamsportWilliamsport, IN, CCN 151307 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 8, 1966
Ascension St. Vincent WilliamsportWilliamsport, IN, CCN 153993 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 3, 2001
May 3, 2001

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 166

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

View all 166

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1730136458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W SONGER LN",
            "city": "VEEDERSBURG",
            "state": "IN",
            "postal_code": "479878547",
            "telephone_number": "765-294-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W SONGER LN",
            "city": "VEEDERSBURG",
            "state": "IN",
            "postal_code": "479878547",
            "telephone_number": "765-294-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT WILLIAMSPORT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. VINCENT WILLIAMSPORT HOSPITAL",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "MARLATT",
        "authorized_official_first_name": "TRINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "765-762-4000",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "IN",
            "license": "050050921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200307100B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension St. Vincent Williamsport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Vincent South Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St. Vincent South Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Veedersburg, IN

Sources for this page

Verify at the official NPI Registry.