NPIMap

Organization Active NPI

Community Hospital of Bremen, Inc.

  • Internal Medicine Physician
  • Bremen, IN
National Provider Identifier
1902017080
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COMMUNITY HOSPITAL OF BREMEN, INC.
Practice address
1020 High Road
Bremen, IN 46506
Phone
(574) 546-2211
Fax
(574) 546-4312
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Authorized official

Name
Irene Maffetone
Title
Contracting Specialist
Phone
(574) 647-1040

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1020 High Road
Bremen, IN 46506

Mailing address

1020 High Road
P.O. Box 8
Bremen, IN 46506
Phone (574) 546-2211

Other identifiers 1

IdentifierTypeStateIssuer
300082798MedicaidIN

Other names 1

  • Community Hospital of Bremen Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040601000388 IN Part B Supplier - Clinic/Group Practice 6002897451 Receives reassigned benefits from 12 practitioners
Practice locations: Bremen, IN

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Community Hospital of B4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1020 High Rd
Bremen, IN 46506
Phone (574) 309-9967

1724 W Plymouth St
Bremen, IN 46506
Phone (219) 546-3045

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724284800000",
    "number": "1902017080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 HIGH ROAD",
            "address_2": "P.O. BOX 8",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "46506",
            "telephone_number": "574-546-2211",
            "fax_number": "574-546-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 HIGH ROAD",
            "city": "BREMEN",
            "state": "IN",
            "postal_code": "46506",
            "telephone_number": "574-546-2211",
            "fax_number": "574-546-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL OF BREMEN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2024-08-22",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "MAFFETONE",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "CONTRACTING SPECIALIST",
        "authorized_official_telephone_number": "574-647-1040"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300082798",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Hospital of Bremen",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bremen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.

Verify at the official NPI Registry.