NPIMap

Organization Active NPI

Pulaski Memorial Hospital

Doing business as Pulaski Memorial Hospital North Judson Family Medicine

  • Rural Health Clinic/Center
  • North Judson, IN
National Provider Identifier
1831679620
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PULASKI MEMORIAL HOSPITAL
Doing business as
Pulaski Memorial Hospital North Judson Family Medicine
Practice address
414 Lane St
North Judson, IN 46366-1226
Phone
(574) 896-4325
NPI assigned
Aug 21, 2018
Last updated
Oct 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PULASKI MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Authorized official

Name
Gregg Malott
Title
Cfo
Phone
(574) 946-2103

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X
Rural Health Clinic/Center 261QR1300X Primary

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 1

IdentifierTypeStateIssuer
300014361MedicaidIN

Other names 1

  • Pulaski Memorial Hospital North Judson Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831679620. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
414 Lane St
North Judson, IN 46366-1226
Related CCNs
151305

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

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2137056Pulaski Memorial Hospital D/B/a North Judson414 Lane St, North Judson, IN 46366Certificate of waiverJun 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
Cindy Parker MD43 organizations share this tax ID, including this one
Part of
Cindy Parker MD

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Marilyn Newman Individual Corporate DirectorBoard of Trustees Oct 31, 2018
Gregg a Malott Individual Corporate OfficerDirector of Business Development Oct 1, 2017
W-2 Managing EmployeeDirector of Business Development Apr 9, 2007
Pulaski Memorial Hospital Organization, Winamac, IN 5% Or Greater Direct Ownership Interest Jan 1, 1989 100%
Operational/Managerial Control Jan 1, 1989 100%
Caitlin Barry Individual Corporate OfficerVP Strategic Partner & Compliance Nov 30, 2020
Michael McKay Individual Corporate DirectorBoard of Trustees Jul 1, 2022
William Fox Individual Corporate OfficerVP of Clinic Operations Jan 1, 2019
Jennifer Smith Individual Corporate DirectorBoard of Trustees Feb 22, 2022
Curtis M Bejes Individual Corporate DirectorRHC Medical Director Aug 31, 2016
W-2 Managing EmployeeMedical Director Aug 31, 2016
Adam Bennett Individual Corporate DirectorBoard of Trustees Jan 1, 2022
Stephen Jarosinski Individual Corporate DirectorCeo Jan 1, 2022
Valerie J Leman Individual Corporate DirectorBoard of Trustees Sep 25, 2012
Clinton Kauffman Individual Corporate DirectorBoard of Trustees Aug 1, 2019
Charles R Hutton Individual Corporate DirectorBoard of Trustees Aug 27, 2002

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 27

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

FacilityTypeRoleSince
Envive of River CityEvansville, IN, CCN 155520 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2014
Jul 1, 2014
Majestic Care of West AllenFort Wayne, IN, CCN 155322 Skilled nursing facility Operational/Managerial Control (100%) Jun 1, 2015
Parkview HavenFrancesville, IN, CCN 155746 Skilled nursing facility Operational/Managerial Control (100%) Sep 1, 2015
Kingston Health Center of Fort WayneFort Wayne, IN, CCN 155479 Skilled nursing facility Operational/Managerial Control (100%) Dec 16, 2025
Northern Lakes Nursing and Rehabilitation CenterAngola, IN, CCN 155449 Skilled nursing facility Operational/Managerial Control (100%) Oct 1, 2015
The Milton HomeSouth Bend, IN, CCN 155738 Skilled nursing facility Operational/Managerial Control (100%) Dec 1, 2016
Simmons Loving Care Health FacilityGary, IN, CCN 155845 Skilled nursing facility Operational/Managerial Control (100%) May 1, 2018
Maple Manor Christian HomeSellersburg, IN, CCN 155766 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2019
Saint AnthonyCrown Point, IN, CCN 155214 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020
Majestic Care of Jefferson PointeFort Wayne, IN, CCN 155446 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020
Majestic Care of AvonAvon, IN, CCN 155338 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2020
Cardinal Care StrategiesMuncie, IN, CCN 155400 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 27, 2021
Majestic Care of CarmelCarmel, IN, CCN 155618 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Majestic Care of SouthportIndianapolis, IN, CCN 155247 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Poplar Care StrategiesLoogootee, IN, CCN 155374 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Sycamore Care StrategiesLoogootee, IN, CCN 155263 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2022
Gentle Care StrategiesVincennes, IN, CCN 155519 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 1, 2022
Heritage CenterEvansville, IN, CCN 155104 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2023
Saint AnthonyWinamac, IN, CCN 155436 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2023
Hickory Creek at RochesterRochester, IN, CCN 155430 Skilled nursing facility Operational/Managerial Control (100%) Apr 1, 2023
Briarcliff Health & Rehabilitation CenterSouth Bend, IN, CCN 155831 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 2024
South Shore Health & Rehabilitation CenterGary, IN, CCN 155530 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 2024
Asbury Towers Health Care CenterGreencastle, IN, CCN 155758 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2024
Jul 1, 2024
Pulaski Memorial HospitalWinamac, IN, CCN 158512 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 MedicineFrancesville, IN, CCN 158528 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 CenterKnox, IN, CCN 158554 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 CenterCulver, IN, CCN 158581 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2024
Jan 1, 2024

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1831679620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "469960279",
            "telephone_number": "574-946-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 LANE ST",
            "city": "NORTH JUDSON",
            "state": "IN",
            "postal_code": "463661226",
            "telephone_number": "574-896-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PULASKI MEMORIAL HOSPITAL",
        "enumeration_date": "2018-08-21",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A",
        "authorized_official_last_name": "MALOTT",
        "authorized_official_first_name": "GREGG",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-946-2103"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300014361",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pulaski Memorial Hospital North Judson Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Judson, IN

Sources for this page

Verify at the official NPI Registry.