Deaconess Clinic Inc
Organization Active NPI Family Medicine Physician · Santa Claus, IN
NPI 1962293936 · NPPES record last updated May 16, 2025
Key facts
- NPI
- 1962293936
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEACONESS CLINIC INC
- Practice address
- 92 W Christmas Blvd
Santa Claus, IN 47579-6044 - Phone
- (812) 937-4120
- Fax
- (812) 996-7074
- NPI assigned
- May 16, 2025
- Organization subpart
- No
Authorized official
- Name
- Cheryl Annette Wathen
- Title
- Cfo
- Phone
- (812) 450-3296
Corporate family (same tax ID) 13
Practitioners 3
-
Debra Schroer, NP
-
Paige A Tolbert, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080922000145 | IN | Part B Supplier - Clinic/Group Practice | 3375610116 |
Receives reassigned benefits from 477 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Deaconess Clinc Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Pediatrics Physician |
208000000X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
92 W Christmas Blvd
Santa Claus, IN 47579-6044
Mailing address
PO Box 631767
Cincinnati, OH 45263-2767
Phone (812) 450-6879
Other providers in Santa Claus, IN
- Lawrence B Ball
- Cheryl Anne Crawford
- Deaconess Memorial Medical Center Inc
- Deaconess Specialty Physicians Inc
- Erin E Morrison
- Melinda J Gruber
- Jessica Knies
All providers in Santa Claus, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.