NPIMap

Organization Active NPI

NW Indiana-Amg Specialty Hospital, Inc.

Doing business as NW Indiana-AMG Specialty Hospital

  • Long Term Care Hospital
  • Crown Point, IN
National Provider Identifier
1760257968
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
NW INDIANA-AMG SPECIALTY HOSPITAL, INC.
Doing business as
NW Indiana-AMG Specialty Hospital
Practice address
9509 Georgia St
Crown Point, IN 46307-6518
Phone
(219) 472-2200
Fax
(219) 472-2147
NPI assigned
Nov 17, 2023
Last updated
Nov 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Authorized official

Name
Ms. Jessica Lane McGee
Title
Cfo
Phone
(337) 269-9566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X Primary

Addresses

Primary practice location

9509 Georgia St
Crown Point, IN 46307-6518

Mailing address

101 La Rue France Ste 500
Lafayette, LA 70508-3144
Phone (337) 269-9566

Other names 1

  • NW Indiana-AMG Specialty Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231228002747 IN Part A Provider - Hospital 6901256288 Practice locations: Crown Point, IN
O20240501000484 IN Part B Supplier - Clinic/Group Practice 6901256288 Receives reassigned benefits from 1 practitioner
Practice locations: Crown Point, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760257968. Details of each certification follow.

Hospital certification: CCN 152028

Legal name
NW INDIANA-AMG SPECIALTY HOSPITAL INC
Doing business as
NW INDIANA-AMG SPECIALTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Feb 1, 2009
Last certification
Jun 21, 2023
Beds
40
Ownership / control type
Private (for profit)
Most recent change of ownership
Jan 1, 2024 (2 total)
Organization structure
CorporationProprietary
Enrollment address
9509 Georgia St
Crown Point, IN 46307-6518
Main/Primary Hospital Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
NW Indiana-Amg Specialty HospitalCCN 152028 · All quality measures
Ownership
For profit
Certified
Feb 1, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Beds
40

National Provider Directory

National Provider Directory
Tax ID family
NW Indiana-Amg Hospital Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Rantz IV Enterprises LLC Organization, Lafayette, LA LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 40%
Timothy W Howard Individual 5% Or Greater Indirect Ownership InterestCeo Jan 1, 2024 40%
Corporate OfficerCeo Jan 1, 2024 50%
Jessica L McGee Individual 5% Or Greater Indirect Ownership InterestCfo Jan 1, 2024 10%
Corporate OfficerCfo Jan 1, 2024 25%
Amg 3.0, LLC Organization, Lafayette, LA LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2024 100%
Keshia Clark Individual W-2 Managing EmployeeAd; Jul 7, 2025 50%
Benjamin Miller Individual 5% Or Greater Indirect Ownership InterestCoo Jan 1, 2024 10%
Corporate OfficerCoo Jan 1, 2024 50%
August J Rantz Individual 5% Or Greater Indirect Ownership InterestPresident Jan 1, 2024 40%
Corporate OfficerPresident Jan 1, 2024 50%

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1700179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1760257968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LA RUE FRANCE STE 500",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083144",
            "telephone_number": "337-269-9566",
            "fax_number": "337-269-9823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9509 GEORGIA ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463076518",
            "telephone_number": "219-472-2200",
            "fax_number": "219-472-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW INDIANA-AMG SPECIALTY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-17",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "MCGEE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "LANE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-269-9566",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW Indiana-AMG Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crown Point, IN

Sources for this page

Verify at the official NPI Registry.