NPIMap

Organization Active NPI

Good Samaritan Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Vincennes, IN
National Provider Identifier
1831808971
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Practice address
300 N 1St St
Vincennes, IN 47591-1252
Phone
(812) 885-2718
Fax
(812) 885-2727
NPI assigned
Nov 17, 2022
Organization subpart
Yes
Parent organization
-As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Jennifer Emmons
Title
Ceo
Phone
(812) 494-7800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

300 N 1St St
Vincennes, IN 47591-1252

Mailing address

PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190219002426 IN Part B Supplier - Clinic/Group Practice 5294099321 Receives reassigned benefits from 59 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Loogootee, IN; Washington, IN; Vincennes, IN; Petersburg, IN
O20230517000519 IN Part A Provider - Federally Qualified Health Center (FQHC) 5294099321 Practice locations: Vincennes, IN

Federally qualified health center certification: CCN 151185

Legal name
GOOD SAMARITAN FAMILY HEALTH CENTER INC
Doing business as
RIVERFRONT FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 16, 2023
Last certification
May 16, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 25, 2017 in IN
Enrollment address
300 N 1St St
Vincennes, IN 47591-1252

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Family Health Center Inc30 organizations share this tax ID, including this one
Part of
Good Samaritan Family Health Center Inc

Other organizations with this tax ID 29

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

View all 29

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Stanley Graber Individual Corporate OfficerCfo Jul 1, 2023
Bridgett Bilskie Individual W-2 Managing EmployeePayor Contract Manager Jul 1, 2023
Jennifer Emmons Individual 5% Or Greater Direct Ownership InterestCeo Jul 1, 2023 100%
Libby Gartner Individual OtherVice Chairman Oct 1, 2019
Philip Mangin Individual OtherChairman Oct 1, 2019
Traci French Individual Corporate DirectorChief Exec Officer Is, Quality, Rev Jul 1, 2023

NPI Registry JSON

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

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1831808971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 556",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475910556",
            "telephone_number": "812-494-9501",
            "fax_number": "812-494-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N 1ST ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911252",
            "telephone_number": "812-885-2718",
            "fax_number": "812-885-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "-",
        "enumeration_date": "2022-11-17",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "EMMONS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-494-7800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vincennes, IN

Sources for this page

Verify at the official NPI Registry.