NPIMap

Organization Active NPI

Shenandoah Memorial Hospital Inc.

  • Rural Health Clinic/Center
  • Mount Jackson, VA
National Provider Identifier
1053842468
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SHENANDOAH MEMORIAL HOSPITAL INC.
Practice address
5173 Main St
Mount Jackson, VA 22842-9513
Phone
(540) 459-1350
Fax
(540) 459-1351
NPI assigned
Mar 27, 2017
Last updated
Apr 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Authorized official

Name
Renee Y Baker
Title
Manger, Insurance Credentialing
Phone
(540) 536-0231

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU
Diagnostic Radiology Physician 2085R0202X NU

Addresses

Primary practice location

5173 Main St
Mount Jackson, VA 22842-9513

Mailing address

5173 Main St
Mount Jackson, VA 22842-9513
Phone (540) 459-1350

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115001156 VA Part B Supplier - Clinic/Group Practice 2466360375 Receives reassigned benefits from 455 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Strasburg, VA; Woodstock, VA; New Market, VA; Mount Jackson, VA; Luray, VA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1053842468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5173 MAIN ST",
            "city": "MOUNT JACKSON",
            "state": "VA",
            "postal_code": "228429513",
            "telephone_number": "540-459-1350",
            "fax_number": "540-459-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5173 MAIN ST",
            "city": "MOUNT JACKSON",
            "state": "VA",
            "postal_code": "228429513",
            "telephone_number": "540-459-1350",
            "fax_number": "540-459-1351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-27",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "MANGER, INSURANCE CREDENTIALING",
        "authorized_official_telephone_number": "540-536-0231"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Jackson, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.