NPIMap

Organization Active NPI

Smyth County Community Hospital

  • General Acute Care Hospital
  • Marion, VA
National Provider Identifier
1073519377
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
H1902 Issued in VA
Legal business name
SMYTH COUNTY COMMUNITY HOSPITAL
Practice address
245 Medical Park Dr
Marion, VA 24354-1100
Phone
(276) 378-1000
Fax
(276) 378-1205
NPI assigned
Jun 22, 2005
Last updated
Apr 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Authorized official

Name
Shane Edwin Hilton
Title
Evp/Cfo
Phone
(423) 302-3467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X H1902 VA Primary

Addresses

Primary practice location

245 Medical Park Dr
Marion, VA 24354-1100

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (276) 378-1000

Other identifiers 2

IdentifierTypeStateIssuer
004900383MedicaidVA
007678OtherVAANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other Smyth County Community Hospital

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000352 VA Part A Provider - Hospital 0446168496 2 other NPIs on this enrollment
Practice locations: Marion, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073519377. Details of each certification follow.

Hospital certification: CCN 490038

Legal name
SMYTH COUNTY COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 26, 2008
Beds
170
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1961 in VA
Enrollment address
245 Medical Park Dr
Marion, VA 24354-1100
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Smyth County Community HospitalCCN 490038 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1326 Eisenhower Dr
Savannah, GA 31406
Phone (912) 691-4100

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Shane Hilton Individual Corporate OfficerEvp/Cfo Apr 4, 2024
Corporate DirectorEvp.Cfo Apr 4, 2024
Gregory Wilgocki Individual Corporate DirectorSVP Feb 1, 2018
W-2 Managing EmployeeSVP Feb 1, 2018
Ballad Health Organization, Johnson City, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2018 100%
Marvin Eichorn Individual Corporate OfficerEvp/Cao Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Mountain States Health Alliance Organization, Johnson City, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 10, 2021 100%
Buford Deaton Individual Corporate OfficerEvp/Coo Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Alan Levine Individual Corporate OfficerCeo/President Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Julie Bennett Individual Corporate OfficerEvp/Clo Feb 1, 2023
Corporate DirectorBoard Member Feb 1, 2023

Owners & managing parties with NPI records 21

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

View all 21

Facilities with the same owner 41

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

View all 41

Practitioners & affiliated clinicians

Affiliated clinicians 234

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

View all 234

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1073519377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PRINCETON RD STE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012026",
            "telephone_number": "276-378-1000",
            "fax_number": "276-378-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 MEDICAL PARK DR",
            "city": "MARION",
            "state": "VA",
            "postal_code": "243541100",
            "telephone_number": "276-378-1000",
            "fax_number": "276-378-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMYTH COUNTY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "HILTON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3467"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "VA",
            "license": "H1902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004900383",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "007678",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1340.1",
            "affiliationName": "Smyth County Community Hospital",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "245 Medical Park Dr",
            "city": "Marion",
            "state": "VA",
            "country_code": "US",
            "postal_code": "243541100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marion, VA

Sources for this page

Verify at the official NPI Registry.