NPIMap

Organization Active NPI

Deaconess Hospital, Inc

Doing business as Deaconess Medical Group - Specialty

  • MOHS-Micrographic Surgery Physician
  • Evansville, IN
National Provider Identifier
1952325409
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
DEACONESS HOSPITAL, INC
Doing business as
Deaconess Medical Group - Specialty
Practice address
519 Harriet St
Evansville, IN 47710-1715
Phone
(812) 423-9699
Fax
(812) 434-2025
NPI assigned
Jul 27, 2006
Last updated
Oct 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

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

Authorized official

Name
Richard M Stivers
Title
Sr Vice President, Cfo
Phone
(812) 450-3296

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Infectious Disease Physician 207RI0200X
Rheumatology Physician 207RR0500X

Addresses

Primary practice location

519 Harriet St
Evansville, IN 47710-1715

Mailing address

PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-6815

Other identifiers 2

IdentifierTypeStateIssuer
CG1119OtherINRR MCARE GROUP #
65931586MedicaidKY

Other names 1

  • Deaconess Medical Group - Specialty Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000129 IN Part B Supplier - Clinic/Group Practice 9032021431 Receives reassigned benefits from 719 practitioners
43 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evansville, IN; Newburgh, IN

Other NPIs on the same Medicare enrollment 43

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

View all 43

National Provider Directory

National Provider Directory

Locations

519 Harriet St
Evansville, IN 47710
Phone (812) 423-9699

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1952325409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3407",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477333407",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 HARRIET ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101715",
            "telephone_number": "812-423-9699",
            "fax_number": "812-434-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "STIVERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VICE PRESIDENT, CFO",
        "authorized_official_telephone_number": "812-450-3296"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCARE GROUP #",
            "identifier": "CG1119",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65931586",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deaconess Medical Group - Specialty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; 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.