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Deaconess Memorial Medical Center, Inc

Organization Active NPI Family Medicine Physician · Loogootee, IN

NPI 1740360700 · NPPES record last updated Mar 16, 2026

Key facts

NPI
1740360700
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
DEACONESS MEMORIAL MEDICAL CENTER, INC
Practice address
105 Cooper St
Loogootee, IN 47553
Phone
(812) 295-2812
Fax
(812) 295-3726
NPI assigned
Oct 16, 2006
Organization subpart
Yes
Parent organization (as reported)
DEACONESS MEMORIAL MEDICAL CENTER

Authorized official

Name
Keith Miller
Title
Cao & Indiana Region President
Phone
(812) 996-0507

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 36

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

View all 36

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 25

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

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

Facilities with the same owner 28

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

View all 28

Practitioners 142

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

View all 142

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IN

Rural health clinic certification: CCN 158508

Legal name
DEACONESS MEMORIAL MEDICAL CENTER INC
Doing business as
LOOGOOTEE FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 14, 2009
Last certification
Nov 1, 2024
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Enrollment address
105 Cooper St
Loogootee, IN 47553-2223
Related CCNs
150115

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Tonya S Heim
Individual 		Corporate Director Sep 27, 2010
Kristi M Nord
Individual 		Corporate Director Jan 1, 2024
Renee Cunningham
Individual 		Corporate Director
Board Secretary		 Jan 1, 2012
W-2 Managing Employee Jan 1, 2012
Sohail Qadir
Individual 		Corporate Director Jul 1, 2015
Shannon Ebenkamp
Individual 		W-2 Managing Employee
Director of Finance		 Oct 8, 2024
James a Huebner
Individual 		Corporate Director Jan 1, 2014
Deaconess Health System Inc
Organization · Evansville, IN
Corporation, Chain home office 		5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Operational/Managerial Control Feb 1, 2024
Lynn C Lingafelter
Individual 		Corporate Director Feb 1, 2024
Christian Blome
Individual 		Corporate Director Feb 1, 2024
Shawn W McCoy
Individual 		Corporate Director Feb 1, 2024
Keith Miller
Individual 		Corporate Officer
Cao & Indian Region President		 Oct 8, 2024
W-2 Managing Employee
Ad;		 Oct 8, 2024
James Porter
Individual 		Corporate Director Feb 1, 2024
Donna Balka
Individual 		Corporate Director May 1, 2021
Nicholas a Werne
Individual 		Corporate Director Aug 5, 2022

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mission Behavioral Health Hospital
Huntingburg, IN · CCN 154072		 Hospital 5% Or Greater Direct Ownership Interest (50%) Apr 5, 2024
Dale Family Medicine
Dale, IN · CCN 153859		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 2, 2000

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031118000733 IN Part B Supplier - Clinic/Group Practice 4587578042 Receives reassigned benefits from 170 practitioners
36 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jasper, IN; Shoals, IN; Loogootee, IN; Montgomery, IN; Petersburg, IN; Santa Claus, IN; Washington, IN; Dale, IN…
O20090910000108 IN Part a Provider - Rural Health Clinic 4587578042 Practice locations: Loogootee, IN

National Provider Directory

Tax ID family
Little Company Hosp in Inc (26 organizations share this tax ID)
Part of
Little Company Hosp in Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Rural Health Clinic/Center 261QR1300X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

105 Cooper St
Loogootee, IN 47553

Mailing address

800 W 9TH St
Jasper, IN 47546-2514

Other identifiers

IdentifierTypeStateIssuer
CB3118OtherINRAILROAD MEDICARE
200048850EMedicaidIN

Other names

  • Loogootee Family Medicine Doing business as

Other providers in Loogootee, IN

All providers in Loogootee, IN · Family Medicine Physician in Indiana

Sources for this page

Verify at the official NPI Registry.