NPIMap

Organization Active NPI

Central Indiana-Amg Specialty Hospital, LLC

  • Long Term Care Hospital
  • Muncie, IN
National Provider Identifier
1962761379
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
CENTRAL INDIANA-AMG SPECIALTY HOSPITAL, LLC
Practice address
2401 W University Ave
5TH Floor East Tower
Muncie, IN 47303-3428
Phone
(765) 751-5253
Fax
(765) 289-5170
NPI assigned
May 7, 2012
Last updated
Nov 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Authorized official

Name
Jessica L. McGee
Title
Cfo
Phone
(337) 269-9566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X Primary

Addresses

Primary practice location

2401 W University Ave
5TH Floor East Tower
Muncie, IN 47303-3428

Mailing address

101 La Rue France Ste 500
Lafayette, LA 70508-3144
Phone (337) 269-9566

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20120702000163 IN Part A Provider - Hospital 5991960668 Practice locations: Muncie, IN
O20130822000021 IN Part B Supplier - Clinic/Group Practice 5991960668 Receives reassigned benefits from 10 practitioners
Practice locations: Muncie, IN
O20251212000276 IN Part A Provider - Hospital 5991960668 Practice locations: Greenfield, IN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1962761379. Details of each certification follow.

Hospital certification: CCN 152025

Legal name
CENTRAL INDIANA-AMG SPECIALTY HOSPITAL, LLC
Doing business as
CENTRAL INDIANA-AMG SPECIALTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Feb 16, 2005
Last certification
Oct 19, 2012
Beds
32
Ownership / control type
Private (for profit)
Most recent change of ownership
Jun 1, 2012 (2 total)
Organization structure
LLCProprietary
Enrollment address
2401 W University Ave
FL 5
Muncie, IN 47303-3428
Other Hospital Practice Location
Hospital subgroups
Long-term

Hospital certification: CCN 15202500

Legal name
CENTRAL INDIANA-AMG SPECIALTY HOSPITAL, LLC
Doing business as
CENTRAL INDIANA-AMG SPECIALTY HOSPITAL
Organization structure
LLCProprietary
Enrollment address
801 N State St
2ND Floor East
Greenfield, IN 46140-1270
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Central Indiana Amg Specialty Hospital LLCCCN 152025 · All quality measures
Ownership
For profit
Certified
Feb 16, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Beds
32

National Provider Directory

National Provider Directory
Tax ID family
Central Indiana Amg Hos LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

801 N State St
Fl 2
Greenfield, IN 46140
Phone (317) 447-6789

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Amg 2 0 Holdco Inc Organization, Lafayette, LA Corporation 5% Or Greater Indirect Ownership Interest Dec 27, 2019 100%
Amg 2 0 LLC Organization, Lafayette, LA LLC 5% Or Greater Direct Ownership Interest Apr 20, 2018 100%
Timothy W Howard Individual Corporate OfficerCeo Jun 1, 2012 100%
Corporate DirectorBoard Director Dec 27, 2019 100%
Jessica L McGee Individual Corporate OfficerCfo Jun 1, 2012 25%
Candace Moehringer Individual W-2 Managing EmployeeAd; Mar 25, 2025 50%
August J Rantz Individual Corporate OfficerPresident Jun 1, 2012 100%
Corporate DirectorBoard Director Dec 27, 2019 100%
Amg Employee Stock Ownership Plan Organization, Lafayette, LA 5% Or Greater Indirect Ownership Interest Dec 27, 2019 100%

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 10

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.

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1962761379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LA RUE FRANCE STE 500",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083144",
            "telephone_number": "337-269-9566",
            "fax_number": "337-269-9823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W UNIVERSITY AVE",
            "address_2": "5TH FLOOR EAST TOWER",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473033428",
            "telephone_number": "765-751-5253",
            "fax_number": "765-289-5170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL INDIANA-AMG SPECIALTY HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-07",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "MCGEE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-269-9566"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muncie, IN

Sources for this page

Verify at the official NPI Registry.