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Organization Active NPI

St. Vincent Clay Hospital, Inc

  • Critical Access Hospital
  • Brazil, IN
National Provider Identifier
1770533994
Registry record updated Apr 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
060050461 Issued in IN
Legal business name
ST. VINCENT CLAY HOSPITAL, INC
Practice address
1206 E National Ave
Brazil, IN 47834-2718
Phone
(812) 442-2500
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2011

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

Authorized official

Name
Jerry Laue
Title
Administrator
Phone
(812) 442-2602

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Clinic/Center 261Q00000X 060050461 IN
Critical Access Hospital 282NC0060X 060050461 IN Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1206 E National Ave
Brazil, IN 47834-2718

Mailing address

1206 E National Ave
Brazil, IN 47834-2718
Phone (812) 442-2500

Other identifiers 2

IdentifierTypeStateIssuer
200348850AMedicaidIN
200107350MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080109000712 IN Part A Provider - Critical Access Hospital 0143119859 Practice locations: Brazil, IN

Hospital certification: CCN 151309

Legal name
ST. VINCENT CLAY HOSPITAL, INC.
Doing business as
ASCENSION ST. VINCENT CLAY
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 3, 2001
Last certification
Jun 15, 2002
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1206 E National Ave
Brazil, IN 47834-2718
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension St Vincent ClayCCN 151309
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Networks

  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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
Jacob Steve Baker Individual Corporate DirectorBoard Member Jul 1, 2024
Cynthia Dawn Adams Individual Corporate DirectorBoard Member Jul 1, 2024
Carlyle Floyd Individual Corporate DirectorBoard Member Jul 1, 2024
Floyd Grubb Individual Corporate DirectorBoard Member Jul 1, 2024
Michael Todd Emmons Individual Corporate DirectorBoard Member Jul 1, 2024
Dana M Muntz Individual Corporate DirectorBoard Member Jul 1, 2024
Allison Taylor Individual Corporate DirectorBoard Member Jul 1, 2024
Robin Ludlow Individual Corporate DirectorBoard Member Jul 1, 2024
Todd Jones Individual Corporate DirectorBoard Member Jul 1, 2024
Loraine Brown Individual Corporate DirectorBoard Member Jul 1, 2024
Jamie Webster Individual Corporate OfficerAdministrator Jul 1, 2024
W-2 Managing EmployeeAd; Jul 1, 2024
Ascension Health Organization, Saint Louis, MO Non-profit Operational/Managerial Control Jul 10, 2000
St Vincent Health Inc Organization, Indianapolis, IN Non-profit Operational/Managerial Control Jul 10, 2000 100%
Ryan Penrod Individual Corporate DirectorBoard Member Jul 1, 2019

Owners & managing parties with NPI records 1

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

Facilities with the same owner 166

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

View all 166

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 96

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

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301616000000",
    "number": "1770533994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 E NATIONAL AVE",
            "city": "BRAZIL",
            "state": "IN",
            "postal_code": "478342718",
            "telephone_number": "812-442-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 E NATIONAL AVE",
            "city": "BRAZIL",
            "state": "IN",
            "postal_code": "478342718",
            "telephone_number": "812-442-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT CLAY HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-04-01",
        "status": "A",
        "authorized_official_last_name": "LAUE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "812-442-2602"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IN",
            "license": "060050461",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IN",
            "license": "060050461",
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200348850A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200107350",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brazil, IN

Sources for this page

Verify at the official NPI Registry.