Pulaski Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · North Judson, IN
NPI 1831679620 · NPPES record last updated Oct 11, 2022
Key facts
- NPI
- 1831679620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PULASKI MEMORIAL HOSPITAL
- Practice address
- 414 Lane St
North Judson, IN 46366-1226 - Phone
- (574) 896-4325
- NPI assigned
- Aug 21, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- PULASKI MEMORIAL HOSPITAL
Authorized official
- Name
- Gregg Malott
- Title
- Cfo
- Phone
- (574) 946-2103
Owners & managing parties with NPI records 4
-
Curtis Mitchell Bejes, M.D.
-
Charles Randall Hutton, D.D.S.
-
Valerie Leman, N.P.
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 42
Related certifications (CCN) 1
Facilities with the same owner 27
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2137056 | Pulaski Memorial Hospital D/B/a North Judson | Certificate of waiver | Jun 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Rural health clinic certification: CCN 158527
- Legal name
- PULASKI MEMORIAL HOSPITAL
- Doing business as
- PULASKI MEMORIAL HOSPITAL NORTH JUDSON FAMILY MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 14, 2018
- Last certification
- Mar 14, 2018
- Ownership / control type
- 2A
- Organization structure
- Government · Non-profit
- Enrollment address
- 414 Lane St
North Judson, IN 46366-1226 - Related CCNs
- 151305
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Marilyn Newman |
Corporate Director |
Oct 31, 2018 | |
| Gregg a Malott |
Corporate Officer |
Oct 1, 2017 | |
| W-2 Managing Employee |
Apr 9, 2007 | ||
| Pulaski Memorial Hospital |
5% Or Greater Direct Ownership Interest | Jan 1, 1989 | 100% |
| Operational/Managerial Control | Jan 1, 1989 | 100% | |
| Caitlin Barry |
Corporate Officer |
Nov 30, 2020 | |
| Michael McKay |
Corporate Director |
Jul 1, 2022 | |
| William Fox |
Corporate Officer |
Jan 1, 2019 | |
| Jennifer Smith |
Corporate Director |
Feb 22, 2022 | |
| Curtis M Bejes |
Corporate Director |
Aug 31, 2016 | |
| W-2 Managing Employee |
Aug 31, 2016 | ||
| Adam Bennett |
Corporate Director |
Jan 1, 2022 | |
| Stephen Jarosinski |
Corporate Director |
Jan 1, 2022 | |
| Valerie J Leman |
Corporate Director |
Sep 25, 2012 | |
| Clinton Kauffman |
Corporate Director |
Aug 1, 2019 | |
| Charles R Hutton |
Corporate Director |
Aug 27, 2002 |
All facility ownership & control disclosures 27
| Facility | Type | Role | Since |
|---|---|---|---|
| Envive of River City |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 1, 2014 Jul 1, 2014 |
| Majestic Care of West Allen |
Skilled nursing facility | Operational/Managerial Control (100%) | Jun 1, 2015 |
| Parkview Haven |
Skilled nursing facility | Operational/Managerial Control (100%) | Sep 1, 2015 |
| Kingston Health Center of Fort Wayne |
Skilled nursing facility | Operational/Managerial Control (100%) | Dec 16, 2025 |
| Northern Lakes Nursing and Rehabilitation Center |
Skilled nursing facility | Operational/Managerial Control (100%) | Oct 1, 2015 |
| The Milton Home |
Skilled nursing facility | Operational/Managerial Control (100%) | Dec 1, 2016 |
| Simmons Loving Care Health Facility |
Skilled nursing facility | Operational/Managerial Control (100%) | May 1, 2018 |
| Maple Manor Christian Home |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2019 |
| Saint Anthony |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2020 |
| Majestic Care of Jefferson Pointe |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 31, 2020 |
| Majestic Care of Avon |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 31, 2020 |
| Cardinal Care Strategies |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 27, 2021 |
| Majestic Care of Carmel |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2021 |
| Majestic Care of Southport |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2021 |
| Poplar Care Strategies |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2022 |
| Sycamore Care Strategies |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2022 |
| Gentle Care Strategies |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Heritage Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| Saint Anthony |
Skilled nursing facility | Operational/Managerial Control (100%) | Apr 1, 2023 |
| Hickory Creek at Rochester |
Skilled nursing facility | Operational/Managerial Control (100%) | Apr 1, 2023 |
| Briarcliff Health & Rehabilitation Center |
Skilled nursing facility | Operational/Managerial Control (100%) | Jan 1, 2024 |
| South Shore Health & Rehabilitation Center |
Skilled nursing facility | Operational/Managerial Control (100%) | Jan 1, 2024 |
| Asbury Towers Health Care Center |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jul 1, 2024 Jul 1, 2024 |
| Pulaski Memorial Hospital |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 20, 2002 Mar 20, 2002 |
| Pulaski Memorial Hospital Francesville Family Medicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 1989 Jan 1, 1989 |
| Pulaski Memorial Hospital Knox Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Sep 1, 2019 Sep 1, 2019 |
| Pulaski Memorial Hospital Culver Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 2024 Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040402000963 | IN | Part B Supplier - Clinic/Group Practice | 3173515509 |
Receives reassigned benefits from 63 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Winamac, IN; North Judson, IN; Monterey, IN; Knox, IN; Francesviille, IN; Culver, IN |
| O20171016003253 | IN | Part a Provider - Rural Health Clinic | 3173515509 |
1 other NPI on this enrollment Practice locations: North Judson, IN |
National Provider Directory
- Tax ID family
- Cindy Parker MD
- Part of
- Cindy Parker MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
414 Lane St
North Judson, IN 46366-1226
Mailing address
PO Box 279
Winamac, IN 46996-0279
Phone (574) 946-2100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300014361 | Medicaid | IN |
Other names
- Pulaski Memorial Hospital North Judson Family Medicine
Other providers in North Judson, IN
- Med One Mobile
- Med One Mobile LLC
- North Judson-San Pierre School Corporation
- Northernwinds Inc
- Adam Steven Novath
- Valerie L Rowe
- Beth Ann Ruff-Crawford
- Thomas G. Wunder
All providers in North Judson, IN · Rural Health Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.