NPIMap

Organization Active NPI

Tulip Tree Health Services of Gibson County, Inc.

Doing business as Tulip Tree Family Health Care

  • Federally Qualified Health Center (FQHC)
  • Fort Branch, IN
National Provider Identifier
1932225372
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
Doing business as
Tulip Tree Family Health Care
Practice address
123 N McCreary St
Fort Branch, IN 47648
Phone
(812) 753-1039
Fax
(812) 753-1122
NPI assigned
Mar 21, 2007
Last updated
Sep 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Mrs. Kristine M Georges
Title
Chief Executive Officer
Phone
(812) 753-1039

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Primary Care Nurse Practitioner 363LP2300X
Clinical Social Worker 1041C0700X
Dentist 122300000X
General Practice Dentistry 1223G0001X
Family Medicine Physician 207Q00000X 02000610 IN

Addresses

Primary practice location

123 N McCreary St
Fort Branch, IN 47648

Mailing address

108 N Main St
Princeton, IN 47670-1540
Phone (812) 753-1039

Other practice location 1

108 N Main St
Princeton, IN 47670-1540
Phone (812) 753-1039

Other identifiers 2

IdentifierTypeStateIssuer
300039487AMedicaidIN
200248220AMedicaidIN

Other names 1

  • Tulip Tree Family Health Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040122000478 IN Part B Supplier - Clinic/Group Practice 7416859376 Receives reassigned benefits from 8 practitioners
Practice locations: Fort Branch, IN; Princeton, IN
O20180802001818 IN Part A Provider - Federally Qualified Health Center (FQHC) 7416859376 Practice locations: Fort Branch, IN
O20200413002256 IN Part A Provider - Federally Qualified Health Center (FQHC) 7416859376 Practice locations: Princeton, IN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1932225372. Details of each certification follow.

Federally qualified health center certification: CCN 151021

Legal name
TULIP TREE HEALTH SERVICES OF GIBSON COUNTY INC
Doing business as
TULIP TREE FAMILY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 2018
Last certification
Aug 1, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 14, 1998 in IN
Enrollment address
123 N McCreary St
Fort Branch, IN 47648-1313

Federally qualified health center certification: CCN 151085

Legal name
TULIP TREE HEALTH SERVICES OF GIBSON COUNTY INC
Doing business as
TULIP TREE FAMILY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 13, 2020
Last certification
Apr 13, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
108 N Main St
Princeton, IN 47670-1540

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0965212Tulip Tree Family Health Care123 N McCreary St, Fort Branch, IN 47648Certificate of waiverMay 20, 2027

National Provider Directory

National Provider Directory

Locations

123 N McCreary St
Fort Branch, IN 47648
Phone (812) 753-1039

108 N Main St
Princeton, IN 47670
Phone (812) 753-1039

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lori Lankford Individual W-2 Managing EmployeeManager of Finance and HR Feb 22, 2021
Operational/Managerial ControlManager of Finance and HR Feb 22, 2021
W-2 Managing EmployeeController Feb 22, 2021
George Ballard Individual Corporate OfficerBoard Secretary Jun 21, 2017
OtherBoard Secretary Mar 1, 2017
Kristine Georges Individual Corporate DirectorExecutive Director Oct 7, 2019
W-2 Managing EmployeeExecutive Director Apr 22, 2019
Operational/Managerial ControlExecutive Director Oct 17, 2019
Corporate OfficerChief Executive Officer Oct 1, 2019 100%
W-2 Managing EmployeeChief Executive Officer Oct 1, 2019
Amy Ketzner Individual Corporate OfficerBoard Chair Sep 29, 2021
OtherBoard President Mar 1, 2017

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1932225372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N MAIN ST",
            "city": "PRINCETON",
            "state": "IN",
            "postal_code": "476701540",
            "telephone_number": "812-753-1039",
            "fax_number": "812-753-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 N MCCREARY ST",
            "city": "FORT BRANCH",
            "state": "IN",
            "postal_code": "47648",
            "telephone_number": "812-753-1039",
            "fax_number": "812-753-1122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 N Main St",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "IN",
            "postal_code": "476701540",
            "country_code": "US",
            "telephone_number": "812-753-1039",
            "fax_number": "812-753-1122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "GEORGES",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "812-753-1039",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02000610",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300039487A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200248220A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tulip Tree Family Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Branch, IN

Sources for this page

Verify at the official NPI Registry.