NPIMap

Organization Active NPI

Good Samaritan Hospital

Doing business as Samaritan Center - Petersburg

  • Community/Behavioral Health Agency
  • Petersburg, IN
National Provider Identifier
1952309528
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
4030CMHC Issued in IN
Legal business name
GOOD SAMARITAN HOSPITAL
Doing business as
Samaritan Center - Petersburg
Practice address
611 E Main St
Suite 110
Petersburg, IN 47567-1267
Phone
(812) 354-8785
Fax
(812) 354-8786
NPI assigned
Jul 8, 2005
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SAMARITAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Mr. John Manning
Title
VP Behavioral Health/Spec Projects
Phone
(812) 886-6800

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 4030 IN
Addiction (Substance Use Disorder) Counselor 101YA0400X 4030 IN
Clinical Social Worker 1041C0700X 4030 IN
Psychiatry Physician 2084P0800X 4030 IN
Community/Behavioral Health Agency 251S00000X 4030CMHC IN Primary

Addresses

Primary practice location

611 E Main St
Suite 110
Petersburg, IN 47567-1267

Mailing address

515 Bayou St
Vincennes, IN 47591-1034
Phone (812) 886-6800

Other identifiers 6

IdentifierTypeStateIssuer
100270140CMedicaidIN
100270140GMedicaidIN
000000574039OtherINANTHEM PIN FOR THIS LOCATION
165526OtherINMHN GROUP
192466000OtherINMAGELLAN
301936OtherINVALUE OPTIONS FACILITY

Other names 1

  • Samaritan Center - Petersburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031204000723 IN Part B Supplier - Clinic/Group Practice 9436061918 Receives reassigned benefits from 12 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vincennes, IN

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Samaritan Center

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1952309528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 BAYOU ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911034",
            "telephone_number": "812-886-6800",
            "fax_number": "812-886-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E MAIN ST",
            "address_2": "SUITE 110",
            "city": "PETERSBURG",
            "state": "IN",
            "postal_code": "475671267",
            "telephone_number": "812-354-8785",
            "fax_number": "812-354-8786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN HOSPITAL",
        "enumeration_date": "2005-07-08",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "MANNING",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP BEHAVIORAL HEALTH/SPEC PROJECTS",
        "authorized_official_telephone_number": "812-886-6800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IN",
            "license": "4030",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "4030",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "4030",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "4030",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IN",
            "license": "4030CMHC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270140C",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270140G",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN FOR THIS LOCATION",
            "identifier": "000000574039",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN GROUP",
            "identifier": "165526",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "192466000",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS FACILITY",
            "identifier": "301936",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Center - Petersburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.