NPIMap

Organization Active NPI

Deaconess Memorial Medical Center, Inc

Doing business as Loogootee Family Medicine

  • Family Medicine Physician
  • Loogootee, IN
National Provider Identifier
1740360700
Registry record updated Mar 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DEACONESS MEMORIAL MEDICAL CENTER, INC
Doing business as
Loogootee Family Medicine
Practice address
105 Cooper St
Loogootee, IN 47553
Phone
(812) 295-2812
Fax
(812) 295-3726
NPI assigned
Oct 16, 2006
Last updated
Mar 16, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
DEACONESS MEMORIAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2026

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X
Nurse Practitioner 363L00000X

Addresses

Primary practice location

105 Cooper St
Loogootee, IN 47553

Mailing address

800 W 9TH St
Jasper, IN 47546-2514

Other identifiers 2

IdentifierTypeStateIssuer
200048850EMedicaidIN
CB3118OtherINRAILROAD MEDICARE

Other names 1

  • Loogootee Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740360700. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
105 Cooper St
Loogootee, IN 47553-2223
Related CCNs
150115

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 36

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

View all 36

National Provider Directory

National Provider Directory
Tax ID family
Mhhcc Physician Practic27 organizations share this tax ID, including this one
Part of
Mhhcc Physician Practic

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

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 DirectorBoard 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 EmployeeDirector 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 OfficerCao & Indian Region President Oct 8, 2024
W-2 Managing EmployeeAd; 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

Owners & managing parties with NPI records 3

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

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 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773619200000",
    "number": "1740360700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W 9TH ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475462514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 COOPER ST",
            "city": "LOOGOOTEE",
            "state": "IN",
            "postal_code": "47553",
            "telephone_number": "812-295-2812",
            "fax_number": "812-295-3726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS MEMORIAL MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEACONESS MEMORIAL MEDICAL CENTER",
        "enumeration_date": "2006-10-16",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CAO & INDIANA REGION PRESIDENT",
        "authorized_official_telephone_number": "812-996-0507"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200048850E",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB3118",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loogootee Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loogootee, IN

Sources for this page

Verify at the official NPI Registry.