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Greene County General Hospital

Organization Active NPI Rural Health Clinic/Center · Bloomfield, IN

NPI 1821585563 · NPPES record last updated Jul 10, 2019

Key facts

NPI
1821585563
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
180050611 (IN)
Legal business name
GREENE COUNTY GENERAL HOSPITAL
Practice address
55 N Judge St
Bloomfield, IN 47424
Phone
(812) 847-4481
Fax
(844) 658-7526
NPI assigned
Apr 18, 2018
Organization subpart
Yes
Parent organization (as reported)
GREENE COUNTY GENERAL HOSPITAL

Authorized official

Name
Wendy Spurlin
Title
Executive Assistant
Phone
(812) 847-5212

Owners & managing parties with NPI records 11

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

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 9

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

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

Facilities with the same owner 8

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

Practitioners 107

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

View all 107

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN

Rural health clinic certification: CCN 158533

Legal name
GREENE COUNTY GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 18, 2018
Last certification
Dec 18, 2018
Ownership / control type
Non-profit – church related
Organization structure
Government · Non-profit
Enrollment address
55 N Judge St
Bloomfield, IN 47424-1231
Related CCNs
151317

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
Michael Crane
Individual 		Corporate Director Jun 1, 2016 9.09%
Edward L Michael
Individual 		Corporate Director Jan 1, 2013 9.09%
Nancy Hudson
Individual 		Corporate Director
Trustee		 Sep 1, 2020
Rebecca Wittmer
Individual 		Corporate Officer
Cfo		 Jul 14, 2023
W-2 Managing Employee
Cfo		 Jul 14, 2023
Operational/Managerial Control
Cfo		 Jul 14, 2023
Timothy R Warrick
Individual 		Corporate Director Jun 1, 2016 9.09%
Joshua Cullison
Individual 		W-2 Managing Employee
Medical Director		 Jan 1, 2020
Jimmy Fuller
Individual 		Corporate Director
Board Member		 Jun 1, 2019
Greene County General Hospital
Organization · Linton, IN 		5% Or Greater Direct Ownership Interest Jun 18, 2018 100%
Brenda L Reetz
Individual 		Corporate Officer
Ceo		 May 13, 2013 100%
Rick a Graves
Individual 		Corporate Director Jan 1, 2011 9.09%
Peter J Powers
Individual 		Corporate Director Jun 1, 2015 9.09%
Nathan L Abrams
Individual 		Corporate Director Jan 1, 2013 9.09%
Harry Bedwell
Individual 		Corporate Director
Board Member		 Jun 1, 2019
Cheryl Hamilton
Individual 		Corporate Director
Trustee		 May 31, 2020

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greene County General Hospital
Linton, IN · CCN 15Z317		 Hospital Operational/Managerial Control Feb 1, 2003
Greene County General Hospital
Linton, IN · CCN 151317		 Hospital Operational/Managerial Control Feb 1, 2003
Health Center at Glenburn Home
Linton, IN · CCN 155524		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Oct 1, 2013
Nov 6, 2025
Serenity Spring Senior Living at Jasonville
Jasonville, IN · CCN 155303		 Skilled nursing facility Operational/Managerial Control (100%) Nov 1, 2014
Serenity Spring Senior Living at Northwood
Jasper, IN · CCN 155282		 Skilled nursing facility Operational/Managerial Control (100%) Nov 1, 2014
Freelandville Community Home
Freelandville, IN · CCN 155688		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2019
My Westgate Clinic
Newberry, IN · CCN 158534		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 18, 2018
My Worthington Clinic
Worthington, IN · CCN 158538		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 18, 2018
My Linton Clinic
Linton, IN · CCN 158535		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 18, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180516002568 IN Part a Provider - Rural Health Clinic 2961481544 Practice locations: Bloomfield, IN

National Provider Directory

Part of
Greene County Hospital

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 1041C0700X 180050611 IN
Specialist
Group: 193200000X MULTI-SPECIALTY GROUP		 174400000X 180050611 IN
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 180050611 IN
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207V00000X 180050611 IN
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X 180050611 IN
Rural Health Clinic/Center 261QR1300X 180050611 IN Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X 180050611 IN
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X 180050611 IN

Addresses

Primary practice location

55 N Judge St
Bloomfield, IN 47424

Mailing address

1185 N 1000 W
Linton, IN 47441-5282
Phone (812) 847-5212

Other identifiers

IdentifierTypeStateIssuer
300024488MedicaidIN

Other names

  • My Bloomfield Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 10, 2019.

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1821585563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 N 1000 W",
            "city": "LINTON",
            "state": "IN",
            "postal_code": "474415282",
            "telephone_number": "812-847-5212",
            "fax_number": "812-847-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 N JUDGE ST",
            "city": "BLOOMFIELD",
            "state": "IN",
            "postal_code": "47424",
            "telephone_number": "812-847-4481",
            "fax_number": "844-658-7526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENE COUNTY GENERAL HOSPITAL",
        "enumeration_date": "2018-04-18",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "SPURLIN",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "812-847-5212"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "180050611",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "180050611",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "180050611",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "180050611",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "180050611",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IN",
            "license": "180050611",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "180050611",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "180050611",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300024488",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Bloomfield Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomfield, IN

All providers in Bloomfield, IN · Rural Health Clinic/Center in Indiana

Sources for this page

Verify at the official NPI Registry.