NPIMap

Organization Active NPI

Deaconess Memorial Medical Center Inc

Doing business as French Lick Family Medicine

  • Rural Health Clinic/Center
  • French Lick, IN
National Provider Identifier
1881843522
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DEACONESS MEMORIAL MEDICAL CENTER INC
Doing business as
French Lick Family Medicine
Practice address
679 S State Road 145
French Lick, IN 47432-8328
Phone
(812) 936-6400
Fax
(812) 936-6402
NPI assigned
Sep 18, 2008
Last updated
Jun 9, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
DEACONESS MEMORIAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Authorized official

Name
Keith Miller
Title
Cao & Indiana Region President
Phone
(812) 996-0507

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X
Interventional Cardiology Physician 207RI0011X

Addresses

Primary practice location

679 S State Road 145
French Lick, IN 47432-8328

Mailing address

800 W 9TH St
Jasper, IN 47546-2514

Other identifiers 1

IdentifierTypeStateIssuer
200048850VMedicaidIN

Other names 1

  • French Lick 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
O20081113000377 IN Part A Provider - Rural Health Clinic 4587578042 Practice locations: French Lick, IN
O20081211000204 IN Part B Supplier - Clinic/Group Practice 4587578042 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
Practice locations: Bristow, IN; French Lick, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881843522. Details of each certification follow.

Rural health clinic certification: CCN 158507

Legal name
DEACONESS MEMORIAL MEDICAL CENTER INC
Doing business as
FRENCH LICK FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 19, 2009
Last certification
Jun 22, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
679 S State Road 145
French Lick, IN 47432-8328
Related CCNs
150115

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

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Memorial Hospital Healt

Locations

522 S Maple St
French Lick, IN 47432
Phone (812) 936-6400

679 S State Road 145
French Lick, IN 47432
Phone (812) 481-7200

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Edward W Miller Individual Corporate OfficerChief Financial Officer Feb 12, 2018
W-2 Managing EmployeeChief Financial Officer Feb 1, 2024
Tonya S Heim Individual Corporate DirectorBoard Member Jan 1, 2013
Kristi M Nord Individual Corporate Director Jan 1, 2024
Renee Cunningham Individual Corporate DirectorBoard Member Jan 1, 2013
Sohail Qadir Individual Corporate DirectorBoard Member Jul 1, 2015
Shannon Ebenkamp Individual W-2 Managing EmployeeDirector of Finance Oct 8, 2024
James a Huebner Individual Corporate DirectorBoard Member Jan 1, 2014
Deaconess Health System Inc Organization, Evansville, IN Corporation, Chain home office 5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Operational/Managerial Control Feb 1, 2024
Lynn C Lingafelter Individual Corporate Director Feb 1, 2024
Sherril Lueken Individual Corporate DirectorBoard Member Jul 1, 2015
Christian Blome Individual Corporate Director Feb 1, 2024
Shawn W McCoy Individual Corporate Director Feb 1, 2024
Keith Miller Individual Corporate OfficerCao & Indiana Region President Oct 8, 2024
W-2 Managing Employee Oct 8, 2024
James Porter Individual Corporate Director Feb 1, 2024
Donna Balka Individual Corporate DirectorBoard Member May 1, 2021
Nicholas a Werne Individual Corporate DirectorBoard Member Aug 5, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mission Behavioral Health HospitalHuntingburg, IN, CCN 154072 Hospital 5% Or Greater Direct Ownership Interest (50%) Apr 5, 2024
Dale Family MedicineDale, IN, CCN 153859 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 2, 2000

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1881843522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W 9TH ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475462514",
            "fax_number": "812-996-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "679 S STATE ROAD 145",
            "city": "FRENCH LICK",
            "state": "IN",
            "postal_code": "474328328",
            "telephone_number": "812-936-6400",
            "fax_number": "812-936-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS MEMORIAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEACONESS MEMORIAL MEDICAL CENTER INC",
        "enumeration_date": "2008-09-18",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CAO & INDIANA REGION PRESIDENT",
        "authorized_official_telephone_number": "812-996-0507"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200048850V",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "French Lick Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "French Lick Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in French Lick, IN

Sources for this page

Verify at the official NPI Registry.