Active NPI
Johnson Memorial Hospital
- Skilled Nursing Facility
- Columbia City, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 06-000071-1
- Legal business name
- JOHNSON MEMORIAL HOSPITAL
- Practice address
- 640 W Ellsworth St
Columbia City, IN 46725-2302 - Phone
- (260) 248-8101
- Fax
- (260) 248-2644
- NPI assigned
- Jul 22, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Dunkle, MD
- Title
- President/Ceo
- Phone
- (317) 736-3396
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 06-000071-1 | IN | Primary |
| Nursing Facility Supplies (DME) | 332BN1400X | |||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | IN |
Addresses
Primary practice location
640 W Ellsworth St
Columbia City, IN 46725-2302
Mailing address
1125 W Jefferson St
Franklin, IN 46131-2140
Phone (317) 736-3396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100273140A | Medicaid | IN |
Other names 1
- The Waters of Columbia City Skilled Nursing Facility
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130529000504 | IN | Part A Provider - Skilled Nursing Facility | 8527972595 | Practice locations: Columbia City, IN |
Skilled nursing facility certification: CCN 155150
- Legal name
- JOHNSON MEMORIAL HOSPITAL
- Doing business as
- THE WATERS OF COLUMBIA CITY SKILLED NURSING FACILITY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jan 3, 1974
- Last certification
- Oct 21, 2024
- Beds
- 84
- Ownership / control type
- Corporation
- Multi-facility organization
- Infinity Healthcare
- Organization structure
- Government
- Enrollment address
- 640 W Ellsworth St
Columbia City, IN 46725-2302 - Nursing home name
- WATERS OF COLUMBIA CITY SKILLED NURSING FACILITY
- Affiliated entity
- INFINITY HEALTHCARE CONSULTING
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Waters of Columbia City Skilled Nursing Facility
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 3, 1974
- Medicare certification status
- Active
- Certified beds
- 84
- Chain
- Infinity Healthcare Consulting
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Emergency Medical Group
Other organizations with this tax ID 36
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Sullivan, IN
- NPI 1003838194
-
- Skilled Nursing Facility
- Syracuse, IN
- NPI 1023031465
-
- Skilled Nursing Facility
- Fort Wayne, IN
- NPI 1033132477
-
- Skilled Nursing Facility
- Franklin, IN
- NPI 1053301259
-
- Skilled Nursing Facility
- Indianapolis, IN
- NPI 1114940558
-
- Skilled Nursing Facility
- Warsaw, IN
- NPI 1114947686
-
- Skilled Nursing Facility
- Rushville, IN
- NPI 1134142573
-
- Skilled Nursing Facility
- Wabash, IN
- NPI 1144236415
-
- Skilled Nursing Facility
- Columbia City, IN
- NPI 1144627977
-
- Skilled Nursing Facility
- Hope, IN
- NPI 1194747287
-
- Skilled Nursing Facility
- Marion, IN
- NPI 1215111067
-
- Skilled Nursing Facility
- Wabash, IN
- NPI 1235150376
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.
| Name | Role | Since | Share |
|---|---|---|---|
| David H Dunkle | Corporate Officer | Jun 1, 2019 | |
| Corporate Director | Mar 1, 2019 | ||
| Operational/Managerial Control | Mar 1, 2019 | ||
| The Waters of Columbia City Skilled Nursing Facility LLC | Operational/Managerial Control | Nov 1, 2022 | 100% |
| Stephen Baker | Contracted Managing Employee | Mar 1, 2013 | 100% |
| Steven Berkhouse | Corporate Officer | Oct 18, 2021 | |
| Corporate Director | Oct 18, 2021 | ||
| Johnson Memorial Hospital | 5% Or Greater Direct Ownership Interest | Mar 1, 2013 | 100% |
| Robert J Decola | W-2 Managing Employee | Feb 16, 2019 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Franklin, IN
- NPI 1053468041
Corporate Director, Corporate Officer, Operational/Managerial Control
All facility ownership & control disclosures 34
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Millers Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jul 1, 2012 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jul 1, 2012 Jul 1, 2012 |
| The Waters of Lagrange Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Dunkirk Skilled Nursing Facilty | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Sullivan Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Rushville Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Syracuse Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Tipton Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Peru Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Rockport Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Chesterfield Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Fort Wayne Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Wakarusa Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Hartford City Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Castleton Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Middletown Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Huntington Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| The Waters of Hobart Skilled Nursing Facility | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2013 |
| Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2023 |
| Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2013 |
| Millers at Oak Pointe | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2014 |
| The Waters of Wabash Skilled Nursing Facility East | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| The Waters of Wabash Skilled Nursing Facility West | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2015 |
| Millers Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Oct 1, 2015 Jun 1, 2013 Jun 1, 2013 |
| Millers Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Greenwood Village South | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Nov 1, 2016 Nov 1, 2016 Jul 9, 2025 |
| Miller'S Health & Rehab by Miller'S Merry Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jun 1, 2013 Jun 1, 2013 Jun 1, 2013 |
| Compass Park | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Jan 1, 2023 Jan 1, 2023 Jan 1, 2023 |
Facilities with the same owner 34
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Sullivan, IN
- NPI 1003838194
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Syracuse, IN
- NPI 1023031465
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Fort Wayne, IN
- NPI 1033132477
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Franklin, IN
- NPI 1053301259
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Indianapolis, IN
- NPI 1114940558
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Warsaw, IN
- NPI 1114947686
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Rushville, IN
- NPI 1134142573
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Wabash, IN
- NPI 1144236415
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Columbia City, IN
- NPI 1144627977
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Hope, IN
- NPI 1194747287
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Marion, IN
- NPI 1215111067
Johnson Memorial Hospital
-
- Skilled Nursing Facility
- Wabash, IN
- NPI 1235150376
Johnson Memorial Hospital
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153526400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1675036800000",
"number": "1891716932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 W JEFFERSON ST",
"city": "FRANKLIN",
"state": "IN",
"postal_code": "461312140",
"telephone_number": "317-736-3396",
"fax_number": "317-736-2692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 W ELLSWORTH ST",
"city": "COLUMBIA CITY",
"state": "IN",
"postal_code": "467252302",
"telephone_number": "260-248-8101",
"fax_number": "260-248-2644"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOHNSON MEMORIAL HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-22",
"last_updated": "2023-01-30",
"certification_date": "2023-01-30",
"status": "A",
"authorized_official_last_name": "DUNKLE",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "317-736-3396",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IN",
"license": "06-000071-1",
"primary": true
},
{
"code": "332BN1400X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "332BP3500X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
"state": "IN",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100273140A",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Waters of Columbia City Skilled Nursing Facility",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Columbia City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.