NPIMap

Organization Active NPI

Good Samaritan Hospital

  • Emergency Medicine Physician
  • Vincennes, IN
National Provider Identifier
1790771343
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
GOOD SAMARITAN HOSPITAL
Practice address
520 S 7TH St
Vincennes, IN 47591-1038
Phone
(812) 882-5220
NPI assigned
Sep 20, 2005
Last updated
Jan 16, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SAMARITAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Authorized official

Name
Robert D McLin
Title
Ceo
Phone
(812) 885-3193

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Clinical Social Worker 1041C0700X NU
Emergency Medicine Physician 207P00000X NU Primary
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Pulmonary Disease Physician 207RP1001X NU
Psychiatry Physician 2084P0800X NU
Medical Physician Assistant 363AM0700X IN
Nurse Practitioner 363L00000X NU
Certified Registered Nurse Anesthetist 367500000X NU

Addresses

Primary practice location

520 S 7TH St
Vincennes, IN 47591-1038

Mailing address

520 S 7TH St
Vincennes, IN 47591-1038
Phone (812) 882-5220

Other identifiers 1

IdentifierTypeStateIssuer
100270150MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031204000723 IN Part B Supplier - Clinic/Group Practice 9436061918 Receives reassigned benefits from 12 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vincennes, IN

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
Samaritan Center

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1790771343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S 7TH ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911038",
            "telephone_number": "812-882-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S 7TH ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911038",
            "telephone_number": "812-882-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN HOSPITAL",
        "enumeration_date": "2005-09-20",
        "last_updated": "2024-01-16",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "MCLIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-885-3193"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270150",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.