NPIMap

Organization Active NPI

Indiana University Health Paoli Inc

Doing business as IU Health Paoli

  • Critical Access Hospital
  • Paoli, IN
National Provider Identifier
1912984451
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
INDIANA UNIVERSITY HEALTH PAOLI INC
Doing business as
IU Health Paoli
Practice address
642 W Hospital Rd
Paoli, IN 47454-9672
Phone
(812) 723-2811
Fax
(812) 723-7506
NPI assigned
Dec 27, 2005
Last updated
Oct 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Mr. Michael Craig
Title
Cfo
Phone
(812) 353-9171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X IN Primary

Addresses

Primary practice location

642 W Hospital Rd
Paoli, IN 47454-9672

Mailing address

642 W Hospital Rd
Paoli, IN 47454-9672
Phone (812) 723-2811

Other identifiers 7

IdentifierTypeStateIssuer
200368930MedicaidIN
200318450MedicaidIN
000000076086OtherINBLUE CROSS
200352690MedicaidIN
200317930MedicaidIN
200318330MedicaidIN
000000107664OtherINBLUE SHIELD

Other names 1

  • IU Health Paoli Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other CIOX HEALTH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071107000404 IN Part A Provider - Critical Access Hospital 2668426016 Practice locations: Paoli, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912984451. Details of each certification follow.

Hospital certification: CCN 151306

Legal name
INDIANA UNIVERSITY HEALTH PAOLI INC
Doing business as
INDIANA UNIVERSITY HEALTH PAOLI HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2001
Last certification
Jan 27, 2010
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Enrollment address
642 W Hospital Rd
Paoli, IN 47454-9672
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Indiana University Health Paoli HospitalCCN 151306 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Bloomington Hospital of O5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

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
Corinna Repetto Individual Corporate Director Jan 1, 2021
Larry Bailey Individual Corporate OfficerCoo Jan 1, 2022
Skylar E Whiteman Individual Corporate DirectorBoard of Directors Jan 1, 2025
Richard Hendrickson Individual Corporate OfficerTreasurer Oct 1, 2016
Corporate DirectorBoard of Directors Oct 1, 2016
Denzil Ross Individual Corporate OfficerInterim President Feb 22, 2024
Corporate Director Feb 22, 2024
Operational/Managerial Control Feb 22, 2024
Indiana University Health Inc Organization, Indianapolis, IN Non-profit Operational/Managerial Control Jan 1, 2010
Joyce Poling Individual Corporate DirectorBoard of Directors Oct 1, 2016
Mohan Shenoy Individual Corporate Director Jan 1, 2021
Whitney Aiken Individual Corporate OfficerSecretary Jan 1, 2026
Kevin Bernard Gebke Individual Corporate DirectorBoard of Directors Aug 16, 2022
Tashera Perry Individual Corporate DirectorBoard of Directors Jan 1, 2025
Paul Quick Individual Corporate DirectorBoard of Directors Jan 1, 2025
Jack Kenworthy Individual Corporate OfficerVice Chairman Oct 1, 2016
Corporate DirectorBoard of Directors Oct 1, 2016
Michael Craig Individual Corporate OfficerCfo Oct 1, 2016
Operational/Managerial ControlCfo Oct 1, 2016
Kent N Rodgers Individual Corporate DirectorBoard of Directors Jan 1, 2026
Kamal Girgis Individual Corporate DirectorBoard of Directors Jan 1, 2026

Owners & managing parties with NPI records 26

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

View all 26

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 210

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 210

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1912984451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 W HOSPITAL RD",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474549672",
            "telephone_number": "812-723-2811",
            "fax_number": "812-723-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 W HOSPITAL RD",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474549672",
            "telephone_number": "812-723-2811",
            "fax_number": "812-723-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH PAOLI INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-353-9171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200368930",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200318450",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000076086",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200352690",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200317930",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200318330",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000000107664",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "CIOX HEALTH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "IU Health Paoli",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IU Health Paoli",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paoli, IN

Sources for this page

Verify at the official NPI Registry.