NPIMap

Organization Active NPI

Shenandoah Memorial Hospital Inc.

Doing business as Valley Health Shenandoah Memorial Hospital Pediatrics

  • Rural Health Clinic/Center
  • Woodstock, VA
National Provider Identifier
1053848069
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SHENANDOAH MEMORIAL HOSPITAL INC.
Doing business as
Valley Health Shenandoah Memorial Hospital Pediatrics
Practice address
759 S Main St
Woodstock, VA 22664-1154
Phone
(540) 459-1325
Fax
(540) 459-1326
NPI assigned
May 22, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

759 S Main St
Woodstock, VA 22664-1154

Mailing address

759 S Main St Ste 106
Woodstock, VA 22664-1154
Phone (540) 459-1325

Other names 1

  • Valley Health Shenandoah Memorial Hospital Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170828001234 VA Part A Provider - Rural Health Clinic 2466360375 Practice locations: Woodstock, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053848069. Details of each certification follow.

Rural health clinic certification: CCN 493426

Legal name
SHENANDOAH MEMORIAL HOSPITAL, INC.
Doing business as
VALLEY HEALTH SHENANDOAH MEMORIAL HOSPITAL PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 11, 2017
Last certification
Nov 13, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 29, 1946 in VA
Enrollment address
759 S. Main Street
Suite 106
Woodstock, VA 22664
Related CCNs
491305

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Health Care Management16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Nelson T Clark Individual Corporate Officer Dec 1, 2015 100%
Shenandoah Memorial Hospital, Inc. Organization, Woodstock, VA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2017 100%
Jill Chambers Individual W-2 Managing Employee Sep 1, 2017

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Shenandoah Memorial Hospital, Inc.Woodstock, VA, CCN 493427 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Valley Health Shenandoah Memorial Hospital Multispecialty ClinicNew Market, VA, CCN 493424 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Valley Health Primary Care StrasburgStrasburg, VA, CCN 493435 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

NPI Registry JSON

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053848069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "759 S MAIN ST STE 106",
            "city": "WOODSTOCK",
            "state": "VA",
            "postal_code": "226641154",
            "telephone_number": "540-459-1325",
            "fax_number": "540-459-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "759 S MAIN ST",
            "city": "WOODSTOCK",
            "state": "VA",
            "postal_code": "226641154",
            "telephone_number": "540-459-1325",
            "fax_number": "540-459-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "MANAGER, INSURANCE CREDENTIALING",
        "authorized_official_telephone_number": "540-536-0231"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health Shenandoah Memorial Hospital Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health Shenandoah Memorial Hospital Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, VA

Sources for this page

Verify at the official NPI Registry.