NPIMap

Organization Active NPI

Greene County General Hospital

Doing business as My Bloomfield Clinic

  • Rural Health Clinic/Center
  • Bloomfield, IN
National Provider Identifier
1821585563
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
180050611 Issued in IN
Legal business name
GREENE COUNTY GENERAL HOSPITAL
Doing business as
My Bloomfield Clinic
Practice address
55 N Judge St
Bloomfield, IN 47424
Phone
(812) 847-4481
Fax
(844) 658-7526
NPI assigned
Apr 18, 2018
Last updated
Jul 10, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GREENE COUNTY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 180050611 IN
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 180050611 IN
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 180050611 IN
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 180050611 IN
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 180050611 IN
Rural Health Clinic/Center 261QR1300X 180050611 IN Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 180050611 IN
Family Nurse PractitionerGroup: 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 names 1

  • My Bloomfield Clinic Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821585563. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
55 N Judge St
Bloomfield, IN 47424-1231
Related CCNs
151317

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Part of
Greene County Hospital

Locations

1210 N 1000 W
Linton, IN 47441
Phone (812) 847-4481

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
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 DirectorTrustee Sep 1, 2020
Rebecca Wittmer Individual Corporate OfficerCfo Jul 14, 2023
W-2 Managing EmployeeCfo Jul 14, 2023
Operational/Managerial ControlCfo Jul 14, 2023
Timothy R Warrick Individual Corporate Director Jun 1, 2016 9.09%
Joshua Cullison Individual W-2 Managing EmployeeMedical Director Jan 1, 2020
Jimmy Fuller Individual Corporate DirectorBoard 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 OfficerCeo 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 DirectorBoard Member Jun 1, 2019
Cheryl Hamilton Individual Corporate DirectorTrustee May 31, 2020

Owners & managing parties with NPI records 11

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

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 HospitalLinton, IN, CCN 15Z317 Hospital Operational/Managerial Control Feb 1, 2003
Greene County General HospitalLinton, IN, CCN 151317 Hospital Operational/Managerial Control Feb 1, 2003
Health Center at Glenburn HomeLinton, 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 JasonvilleJasonville, IN, CCN 155303 Skilled nursing facility Operational/Managerial Control (100%) Nov 1, 2014
Serenity Spring Senior Living at NorthwoodJasper, IN, CCN 155282 Skilled nursing facility Operational/Managerial Control (100%) Nov 1, 2014
Freelandville Community HomeFreelandville, IN, CCN 155688 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2019
My Westgate ClinicNewberry, IN, CCN 158534 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 18, 2018
My Worthington ClinicWorthington, IN, CCN 158538 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 18, 2018
My Linton ClinicLinton, IN, CCN 158535 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 18, 2018

Owned or controlled facilities with NPI records 8

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

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Bloomfield Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomfield, IN

Sources for this page

Verify at the official NPI Registry.