NPIMap

Organization Active NPI

Select Specialty Hospital - West Tennessee, LLC

  • Long Term Care Hospital
  • Jackson, TN
National Provider Identifier
1053023713
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
SELECT SPECIALTY HOSPITAL - WEST TENNESSEE, LLC
Practice address
620 Skyline Drive
5TH and 6TH Floors
Jackson, TN 38301
Phone
(717) 972-1100
NPI assigned
Dec 14, 2022
Last updated
Sep 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Authorized official

Name
John Duggan
Title
VP
Phone
(717) 975-4503

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

620 Skyline Drive
5TH and 6TH Floors
Jackson, TN 38301

Mailing address

4714 Gettysburg Rd
Melanie Notario
Mechanicsburg, PA 17055
Phone (717) 972-1100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230303002155 TN Part A Provider - Hospital 1951774488 Practice locations: Jackson, TN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1053023713. Details of each certification follow.

Hospital certification: CCN 442018

Legal name
SELECT SPECIALTY HOSPITAL - WEST TENNESSEE, LLC
Doing business as
SELECT SPECIALTY HOSPITAL - WEST TENNESSEE
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Feb 1, 2024
Last certification
Feb 1, 2024
Beds
50
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Apr 22, 2021 in DE
Enrollment address
620 Skyline Drive
5TH and 6TH Floors
Jackson, TN 38301
Main/Primary Hospital Location
Hospital subgroups
Long-term

Hospital certification: CCN 440239

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SELECT SPECIALTY HOSPITAL - WEST TENNESSEE
Certification status
Terminated Other: provider status change, Jan 31, 2024
Provider type (POS)
Hospital – Short-term
Participating since
Jun 27, 2023
Last certification
Jun 27, 2023
Beds
50
Ownership / control type
Private (for profit)
Facility address
620 Skyline Drive 5TH & 6TH Floors
Jackson, TN 38301

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Select Specialty Hospital - West TennesseeCCN 442018 · All quality measures
Ownership
For profit
Certified
Feb 1, 2024
Medicare certification status
ActiveFrom the Provider of Services file
Beds
50

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2275995Select Specialty Hospital-West Tennessee, LLC620 Skyline Dr, 5TH & 6TH Floors, Jackson, TN 38301AccreditationDec 18, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Hospital Holdings Corporation Organization, Mechanicsburg, PA Corporation, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2023 85%
Select Medical Corporation Organization, Mechanicsburg, PA Corporation, For-profit, Chain home office 5% Or Greater Indirect Ownership Interest Mar 1, 2023 100%
Operational/Managerial Control Mar 1, 2023 100%
Martin F Jackson Individual Corporate Officer Mar 1, 2023
Jackson Madison County General Hospital Organization, Jackson, TN Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2023 15%
Robert a Ortenzio Individual Corporate Officer Mar 1, 2023
Robert Shannon Canard Individual Corporate OfficerCeo May 19, 2024
W-2 Managing EmployeeAd; May 19, 2024
Operational/Managerial ControlCeo May 19, 2024
David S Chernow Individual Corporate Officer Mar 1, 2023
Select Specialty Hospitals Inc Organization, Mechanicsburg, PA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2023 100%
Michael E Tarvin Individual Corporate OfficerVP Mar 1, 2023
W-2 Managing Employee Mar 1, 2023

Owners & managing parties with NPI records 9

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

Facilities with the same owner 141

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

View all 141

Practitioners & affiliated clinicians

Practitioners 2

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 8

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": "1670976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757462400000",
    "number": "1053023713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "MELANIE NOTARIO",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "17055",
            "telephone_number": "717-972-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DRIVE",
            "address_2": "5TH AND 6TH FLOORS",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38301",
            "telephone_number": "717-972-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT SPECIALTY HOSPITAL - WEST TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-14",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A",
        "authorized_official_last_name": "DUGGAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "717-975-4503"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.