Deaconess Clinic, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DEACONESS CLINIC, INC.

Doing business as

Deaconess Clinic - Wyntree

Practice address

4144 Wyntree Dr
Newburgh, IN 47630-2521

Phone

(812) 858-1957

Fax

(812) 858-1917

NPI assigned

Jul 30, 2020

Organization subpart

No

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

Authorized official

Name

Cheryl Annette Wathen

Title

Cfo

Phone

(812) 450-3296

Specialties & licenses 3

Addresses

Other names 1

• Deaconess Clinic - Wyntree Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

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.

• Deena Marie Bentley, PAC

  • Physician Assistant
  • Newburgh, IN
  • NPI 1255334884
  NPD
• Jennifer Hall, N.P.

  • Nurse Practitioner
  • Newburgh, IN
  • NPI 1124715891
  NPD
• Melinda Brown Jackson, M.D., PHD

  • Family Medicine Physician
  • Newburgh, IN
  • NPI 1558332734
  NPD
• Anna Kavanaugh

  • Nurse Practitioner
  • Newburgh, IN
  • NPI 1962827345
  NPD
• Kelsey Marie Kelly, PA-C

  • Physician Assistant
  • Ferdinand, IN
  • NPI 1083135610
  NPD

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1740899236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4144 WYNTREE DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302521",
            "telephone_number": "812-858-1957",
            "fax_number": "812-858-1917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Clinic - Wyntree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deaconess Clinic, Inc (Deaconess Clinic I)
• Deaconess Clinic, Inc
• Deaconess Clinic, Inc (Deaconess Clinic II)
• Deaconess Clinic, Inc
• Deaconess Clinic, Inc (Deaconess Comp Center Gateway)
• Deaconess Hospital Inc (Deaconess Pulmonary Critical Care - Gateway)
• Deaconess Hospital Inc (Deaconess Clinic Obstetrics and Gynecology Newburgh)
• Deaconess Hospital Inc
• Deaconess Hospital Inc (The Women's Hospital)
• Deaconess Hospital Inc (Deaconess Home Medical Equipment)

• Family Medicine Physician in Newburgh, IN
• Providers in Newburgh, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.