Active NPI
Good Samaritan Hospital
- Community/Behavioral Health Agency
- Vincennes, IN
National Provider Identifier
1861490435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- 4030CMHC
- Legal business name
- GOOD SAMARITAN HOSPITAL
- Practice address
- 121 Buntin St
Vincennes, IN 47591-1320 - Phone
- (812) 885-2700
- Fax
- (812) 885-2716
- NPI assigned
- Jul 8, 2005
- Organization subpart
- Yes
- Parent organization
- GOOD SAMARITAN HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Manning
- Title
- VP Behavioral Health/Spec Projects
- Phone
- (812) 886-6800
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 4030 | IN | |
| Social Worker | 104100000X | 4030 | IN | |
| Clinical Social Worker | 1041C0700X | 4030 | IN | |
| Community/Behavioral Health Agency | 251S00000X | 4030CMHC | IN | Primary |
Addresses
Primary practice location
121 Buntin St
Vincennes, IN 47591-1320
Mailing address
515 Bayou St
Vincennes, IN 47591-1034
Phone (812) 886-6800
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100270140G | Medicaid | IN | |
| 326003 | Other | IN | VALUE OPTIONS |
| 000000574042 | Other | IN | ANTHEM PIN FOR THIS LOCATION |
| 100270140M | Medicaid | IN | |
| 165526 | Other | IN | MHN GROUP |
Other names 1
- Samaritan Center-Buntin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031204000723 | IN | Part B Supplier - Clinic/Group Practice | 9436061918 |
Receives reassigned benefits from 12 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Vincennes, IN |
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community Health Registered Nurse
- Vincennes, IN
- NPI 1033578273
O20031204000723
-
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Vincennes, IN
- NPI 1073153474
O20031204000723
-
- Community/Behavioral Health Agency
- Petersburg, IN
- NPI 1952309528
O20031204000723
-
- Nurse Practitioner
- Vincennes, IN
- NPI 1336576875
O20031204000723
National Provider Directory
National Provider Directory- Part of
- Good Samaritan Hosp
Locations
121 Buntin St
Vincennes, IN 47591
Phone (812) 885-2700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1398297600000",
"number": "1861490435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 BAYOU ST",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475911034",
"telephone_number": "812-886-6800",
"fax_number": "812-886-6809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 BUNTIN ST",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475911320",
"telephone_number": "812-885-2700",
"fax_number": "812-885-2716"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOOD SAMARITAN HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "GOOD SAMARITAN HOSPITAL",
"enumeration_date": "2005-07-08",
"last_updated": "2014-04-24",
"status": "A",
"authorized_official_last_name": "MANNING",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "VP BEHAVIORAL HEALTH/SPEC PROJECTS",
"authorized_official_telephone_number": "812-886-6800"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "4030",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"state": "IN",
"license": "4030",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "4030",
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "IN",
"license": "4030CMHC",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100270140G",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "326003",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PIN FOR THIS LOCATION",
"identifier": "000000574042",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100270140M",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN GROUP",
"identifier": "165526",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Samaritan Center-Buntin",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Vincennes, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.