NPIMap

Organization Active NPI

Perry County Memorial Hospital

Doing business as Main Street Clinic

  • Nurse Practitioner
  • Tell City, IN
National Provider Identifier
1740151489
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PERRY COUNTY MEMORIAL HOSPITAL
Doing business as
Main Street Clinic
Practice address
715 Main St
Tell City, IN 47586-1705
Phone
(812) 548-4480
Fax
(812) 772-0560
NPI assigned
Sep 16, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Authorized official

Name
Crystal Lee Hinton
Title
Provider Enrollment
Phone
(812) 772-0589

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

715 Main St
Tell City, IN 47586-1705

Mailing address

715 Main St
Tell City, IN 47586-1705
Phone (812) 548-4480

Other identifiers 2

IdentifierTypeStateIssuer
300124476MedicaidIN
7101121230MedicaidKY

Other names 1

  • Main Street Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040909000009 IN Part B Supplier - Clinic/Group Practice 6901871276 Receives reassigned benefits from 44 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Leopold, IN; Tell City, IN; Rockport, IN

Other NPIs on the same Medicare enrollment 4

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

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
15D2333656Main Street Clinic715 Main Street, Tell City, IN 47586Provider-performed microscopyMay 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Perry County Memorial H14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

559 Main St
Rockport, IN 47635
Phone (812) 649-2271

115 US Highway 66 E
Tell City, IN 47586
Phone (812) 547-0230

148 13th St
Ste A
Tell City, IN 47586
Phone (812) 547-9661

8885 State Road 237
#1
Tell City, IN 47586
Phone (812) 547-0192

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1757980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1740151489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 MAIN ST",
            "city": "TELL CITY",
            "state": "IN",
            "postal_code": "475861705",
            "telephone_number": "812-548-4480",
            "fax_number": "812-772-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 MAIN ST",
            "city": "TELL CITY",
            "state": "IN",
            "postal_code": "475861705",
            "telephone_number": "812-548-4480",
            "fax_number": "812-772-0560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-16",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "HINTON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "812-772-0589"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300124476",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7101121230",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tell City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.