MEMORIAL HOSPITAL OF SOUTH BEND (NPI# 1376841395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376841395 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HOSPITAL OF SOUTH BEND |
| Other Organization Name | MEMORIAL EPWORTH CENTER |
| Practice Address |
420 N Niles Ave South Bend IN 46617-1918 |
| Mailing Address |
615 N Michigan St South Bend IN 46601-1033 |
| Practice Telephone | 5746478400 |
| Practice Fax Number | 5746478410 |
| Mailing Telephone | 5746477167 |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2020-06-24 |
| Authorized Official Name | MR. JEFFREY P COSTELLO (VP/CFO) |
| Authorized Official Telephone | 5746473549 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | 005053 | IN | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100269890B | 05 |
| Other Name | Type Code |
|---|---|
| Memorial Epworth Center | Doing Business As Name - Organization |
| MEMORIAL EPWORTH CTR GEROPSYCH INST | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881177756 | Memorial Hospital of South Bend | General Acute Care Hospital | 3220 Beacon Parkway, Granger, IN 46530 | 2018-09-07 |
| 1295772093 | Memorial Hospital of South Bend | Emergency Medicine | 615 N Michigan St, South Bend, IN 46601-1033 | 2006-06-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEMORIAL HOSPITAL OF SOUTH BEND | 615 N Michigan St, South Bend, IN 46601-1033 |
| System for Award Management (SAM) Entities | MEMORIAL HOSPITAL OF SOUTH BEND INC | 615 N Michigan St, South Bend, IN 46601-1033 |
| Indiana Business Entities | MEMORIAL HOSPITAL OF SOUTH BEND INC. | 615 N. Michigan St., South Bend, IN 46601 |
| Street Address |
420 N NILES AVE |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617-1918 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740731116 | Jack Mcintyre Kimmell | Specialist/Technologist | 1526 East Lasalle, South Bend, IN 46617 | 2016-10-20 |
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760521140 | Otis R. Bowen Center | Psychiatric Unit | 1535 Provident Dr., Warsaw, IN 46580 | 2007-02-05 |
| 1811042237 | St. Marys Warrick Hospital, Inc. | Psychiatric Unit | 1116 Millis Avenue, Boonville, IN 47601 | 2007-01-24 |
| 1104998624 | Columbus Regional Hospital | Psychiatric Unit | 2400 East 17th St, Columbus, IN 47201-5351 | 2006-11-14 |
| 1821517533 | Indiana University Health Jay, Inc. | Psychiatric Unit | 500 W Votaw St, Portland, IN 47371-1322 | 2017-09-13 |
| 1922463454 | La Porte Hospital Company LLC | Psychiatric Unit | 1007 Lincolnway, La Porte, IN 46350-3201 | 2015-12-29 |
| 1396015251 | The Methodist Hospitals, Inc | Psychiatric Unit | 600 Grant St, Gary, IN 46402-6001 | 2012-01-10 |
| 1760751069 | Nicki Williamson, Msw, Lcsw, LLC | Psychiatric Unit | 101 W Kirkwood Ave, Suite 121, Bloomington, IN 47404-6129 | 2011-12-16 |
| 1730492018 | Indiana Clinic | Psychiatric Unit | 1701 N Senate Blvd, Indianapolis, IN 46202-1239 | 2010-07-15 |
| 1972788784 | James R Davis Md LLC | Psychiatric Unit | 2700 Vissing Park Rd, Jeffersonville, IN 47130-5989 | 2007-12-31 |
| 1548467350 | Indiana University Health Morgan Hospital Inc | Psychiatric Unit | 2209 John R Wooden Dr, Martinsville, IN 46151-1840 | 2007-06-27 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.