NPIMap

Organization Active NPI

Page Memorial Hospital, Inc.

Doing business as Valley Health Shenandoah Medical Associates

  • Rural Health Clinic/Center
  • Front Royal, VA
National Provider Identifier
1083236970
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PAGE MEMORIAL HOSPITAL, INC.
Doing business as
Valley Health Shenandoah Medical Associates
Practice address
625 Virginia Ave
Front Royal, VA 22630-2717
Phone
(540) 635-7991
Fax
(540) 636-2516
NPI assigned
May 13, 2020
Last updated
Jan 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PAGE MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

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

Authorized official

Name
Renee Nevada Johnson
Title
Credentialing Coordinator
Phone
(540) 536-0103

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

625 Virginia Ave
Front Royal, VA 22630-2717

Mailing address

220 Campus Blvd Ste 100
Winchester, VA 22601-2888
Phone (540) 536-5100

Other names 1

  • Valley Health Shenandoah Medical Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129000420 VA Part B Supplier - Clinic/Group Practice 8426951203 Receives reassigned benefits from 386 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stanley, VA; Shenandoah, VA; Luray, VA; Front Royal, VA
O20200626001518 VA Part A Provider - Rural Health Clinic 8426951203 Practice locations: Front Royal, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083236970. Details of each certification follow.

Rural health clinic certification: CCN 493439

Legal name
PAGE MEMORIAL HOSPITAL INC
Doing business as
VALLEY HEALTH SHENANDOAH MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 29, 2020
Last certification
Dec 29, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 17, 1925 in VA
Enrollment address
625 Virginia Ave
Front Royal, VA 22630-2717
Related CCNs
491307

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Part of
Page Memorial Hosptial

Locations

516 1st St
Shenandoah, VA 22849
Phone (540) 652-1207

516B 1st St
Shenandoah, VA 22849
Phone (540) 652-1207

235 Medical Dr
Stanley, VA 22851
Phone (540) 778-3484

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 Jul 1, 2005
Valley Health System Organization, Winchester, VA Corporation 5% Or Greater Direct Ownership Interest Dec 31, 2008 100%
Jill Chambers Individual W-2 Managing Employee Sep 1, 2017

Facilities with the same owner 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 369

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 369

NPI Registry JSON

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1083236970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CAMPUS BLVD STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012888",
            "telephone_number": "540-536-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 VIRGINIA AVE",
            "city": "FRONT ROYAL",
            "state": "VA",
            "postal_code": "226302717",
            "telephone_number": "540-635-7991",
            "fax_number": "540-636-2516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAGE MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAGE MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2020-05-13",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "NEVADA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "540-536-0103"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health Shenandoah Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health Shenandoah Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Front Royal, VA

Sources for this page

Verify at the official NPI Registry.