NPIMap

Organization Active NPI

Deaconess Specialty Physicians Inc

  • Nephrology Physician
  • Henderson, KY
National Provider Identifier
1831996222
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
DEACONESS SPECIALTY PHYSICIANS INC
Practice address
1413 N Elm St
Henderson, KY 42420-2768
Phone
(270) 831-7937
Fax
(270) 831-7939
NPI assigned
Feb 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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

Authorized official

Name
Cheryl Annette Wathen
Title
Cfo
Phone
(812) 450-3296

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

1413 N Elm St
Henderson, KY 42420-2768

Mailing address

PO Box 632111
Cincinnati, OH 45263-2111
Phone (812) 450-6879

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180608001730 KY Part B Supplier - Clinic/Group Practice 0244595205 Receives reassigned benefits from 80 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henderson, KY; Owensboro, KY; Morganfield, KY

Other NPIs on the same Medicare enrollment 12

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
18D2234032Deaconess Specialty Physician, Inc - Endocrinology1413 N Elm Street, Suite 106, Henderson, KY 42420Certificate of waiverAug 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Deaconess Specialty Physicians Inc41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774396800000",
    "number": "1831996222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632111",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632111",
            "telephone_number": "812-450-6879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202768",
            "telephone_number": "270-831-7937",
            "fax_number": "270-831-7939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS SPECIALTY PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-25",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A",
        "authorized_official_last_name": "WATHEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.