NPIMap

Organization Active NPI

St Mary Medical Center Inc

Doing business as St Mary Wound Clinic

  • General Acute Care Hospital
  • Hobart, IN
National Provider Identifier
1962504175
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
060057861 Issued in IN
Legal business name
ST MARY MEDICAL CENTER INC
Doing business as
St Mary Wound Clinic
Practice address
1500 S Lake Park Ave
Hobart, IN 46342-6638
Phone
(219) 947-6448
Fax
(219) 947-6839
NPI assigned
Sep 1, 2006
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ST MARY MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Mrs. Char Kullerstrand
Title
Regional Director
Phone
(219) 934-8999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 060057861 IN Primary

Addresses

Primary practice location

1500 S Lake Park Ave
Hobart, IN 46342-6638

Mailing address

1600 S Lake Park Ave
Ste 1103
Hobart, IN 46342-6641
Phone (219) 947-6448

Other identifiers 1

IdentifierTypeStateIssuer
200031870MedicaidIN

Other names 1

  • St Mary Wound Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040603000490 IN Part B Supplier - Clinic/Group Practice 2365424348 Receives reassigned benefits from 3 practitioners
16 other NPIs on this enrollment
Practice locations: Hobart, IN
O20071119000373 IN Part A Provider - Hospital 2365424348 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Valparaiso, IN; Hobart, IN; Portage, IN; Crown Point, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962504175. Details of each certification follow.

Hospital certification: CCN 150034

Legal name
ST MARY MEDICAL CENTER INC
Doing business as
ST MARY MEDICAL CENTER, INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 10, 2006
Beds
176
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1500 S Lake Park Ave
Hobart, IN 46342-6638
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Mary Medical Center IncCCN 150034 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Ancilla Health Services

Locations

10607 Randolph St
Ste A
Crown Point, IN 46307
Phone (219) 226-1529

1400 S Lake Park Ave
#105
Hobart, IN 46342
Phone (219) 942-5544

1400 S Lake Park Ave
#200
Hobart, IN 46342
Phone (219) 947-6122

1439 S Lake Park Ave
Hobart, IN 46342
Phone (219) 947-6105

1500 S Lake Park Ave
Ste 204
Hobart, IN 46342
Phone (219) 947-6695

1500 S Lake Park Ave
Ste Sp
Hobart, IN 46342

1500 S Lake Park Ave
Ste SP404
Hobart, IN 46342

1600 S Lake Park Ave
Ste 1103
Hobart, IN 46342
Phone (219) 947-6448

164 Bracken Pkwy
Hobart, IN 46342
Phone (219) 942-1145

295 S Wisconsin St
Hobart, IN 46342
Phone (219) 942-1145

320 W 61st Ave
Hobart, IN 46342
Phone (219) 947-6448

101 E 87th Ave
#402
Merrillville, IN 46410
Phone (219) 756-4900

200 E 80th Pl
#100E
Merrillville, IN 46410
Phone (219) 769-7536

200 E 80th Pl
Ste 100
Merrillville, IN 46410
Phone (219) 769-7536

209 E 86th Ct
Merrillville, IN 46410
Phone (219) 736-9042

801 MacArthur Blvd
Ste 402
Munster, IN 46321
Phone (219) 513-0233

3545 Arbor Blvd
Portage, IN 46368
Phone (219) 759-6092

2000 Roosevelt Rd
Ste 5
Valparaiso, IN 46383
Phone (219) 464-2123

3800 Saint Mary Rd
Valparaiso, IN 46383
Phone (219) 286-3700

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Janice L Ryba Individual Corporate OfficerCeo Aug 6, 2007
W-2 Managing Employee Aug 6, 2007
Sharon S Harig Individual Corporate DirectorDirector Jul 1, 2014
Frankie Fesko Individual Corporate DirectorDirector Jul 1, 2013
John Walsh Individual Corporate DirectorDirector Jul 1, 2014
Billy Joiner Individual Corporate DirectorSecretary/Treasurer Jul 1, 2013
Thomas Golubski Individual Corporate DirectorDirector Jul 1, 2012
Dale Clapp Individual Corporate DirectorDirector Jul 1, 2022
Peggy a Buffington Individual Corporate DirectorDirector Jul 1, 2009
Lula McDuffie Individual Corporate DirectorDirector Dec 13, 2023
Community Foundation of Northwest Indiana, Inc Organization, Munster, IN Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Aug 6, 2007 100%
Kunal Bhatt Individual Corporate DirectorMed Staff President Jul 1, 2024
Julie M Latta Individual Corporate OfficerChief Financial Officer Jul 1, 2025
W-2 Managing Employee Jul 1, 2025
Michelle K Dvorak Individual Corporate DirectorVice President Jul 1, 2010
Kenneth V Krupinski Individual Corporate DirectorPresident Jul 1, 2013
Theresa Bosak Individual Corporate DirectorDirector Jul 1, 2023
Rex Richards Individual Corporate DirectorDirector Dec 18, 2019

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Powers Home Health ServicesHobart, IN, CCN 157313 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1996

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 67

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 67

Affiliated clinicians 910

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 910

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1962504175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S LAKE PARK AVE",
            "address_2": "STE 1103",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426641",
            "telephone_number": "219-947-6448",
            "fax_number": "219-947-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426638",
            "telephone_number": "219-947-6448",
            "fax_number": "219-947-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST MARY MEDICAL CENTER INC",
        "enumeration_date": "2006-09-01",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "KULLERSTRAND",
        "authorized_official_first_name": "CHAR",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "219-934-8999",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IN",
            "license": "060057861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200031870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Mary Wound Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Mary Wound Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hobart, IN

Sources for this page

Verify at the official NPI Registry.