NPIMap

Organization Active NPI

State of Indiana Auditor of State

  • Psychiatric Hospital
  • Evansville, IN
National Provider Identifier
1922094481
Registry record updated Aug 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF INDIANA AUDITOR OF STATE
Practice address
3400 Lincoln Avenue
Evansville, IN 47714
Phone
(812) 469-6800
Fax
(812) 469-6847
NPI assigned
Sep 21, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2010

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

Authorized official

Name
Cathe Fulcher
Title
Superintendent
Phone
(812) 469-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

3400 Lincoln Avenue
Evansville, IN 47714

Mailing address

3400 Lincoln Avenue
Evansville, IN 47714
Phone (812) 469-6800

Other identifiers 1

IdentifierTypeStateIssuer
100273500MedicaidIN

Other names 1

  • Evansville State Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101004001331 IN Part A Provider - Hospital 1759280118 Practice locations: Evansville, IN

Hospital certification: CCN 154056

Legal name
STATE OF INDIANA AUDITOR OF STATE
Doing business as
EVANSVILLE STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jan 6, 2012
Last certification
Jan 6, 2012
Beds
168
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
3400 Lincoln Ave
Evansville, IN 47714-0146
Hospital Psychiatric Unit
Hospital subgroups
Other

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Evansville State HospitalCCN 154056
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
State of Indiana Auditor of State32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jeffrey Wedding Individual Corporate DirectorDirector of Operations Oct 24, 2021
State of Indiana Auditor of State Organization, Evansville, IN 5% Or Greater Direct Ownership Interest Jul 22, 2010 100%
Dhiann Kinsworthy Individual Corporate DirectorController, Indiana Family & Soc Jan 1, 2020 100%
W-2 Managing Employee Jan 1, 2022

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Neurodiagnostic InstituteIndianapolis, IN, CCN 154008 Hospital Operational/Managerial Control (100%) Sep 16, 2015
Madison State HospitalMadison, IN, CCN 154019 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2010
Richmond State HospitalRichmond, IN, CCN 154018 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Indiana Veterans HomeWest Lafayette, IN, CCN 155787 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 21, 2011

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1922094481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 LINCOLN AVENUE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47714",
            "telephone_number": "812-469-6800",
            "fax_number": "812-468-6847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 LINCOLN AVENUE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47714",
            "telephone_number": "812-469-6800",
            "fax_number": "812-469-6847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF INDIANA AUDITOR OF STATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-21",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "FULCHER",
        "authorized_official_first_name": "CATHE",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "812-469-6800"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100273500",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evansville State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.