NPIMap

Organization Active NPI

Shelby County Health Care Corporation

Doing business as Regional One Health

  • General Acute Care Hospital
  • Memphis, TN
National Provider Identifier
1144213117
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
SHELBY COUNTY HEALTH CARE CORPORATION
Doing business as
Regional One Health
Practice address
877 Jefferson Ave
Memphis, TN 38103-2807
Phone
(901) 545-6265
Fax
(901) 545-8194
NPI assigned
Aug 25, 2005
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Authorized official

Name
James Proctor
Title
SVP/Chief Financial Officer
Phone
(901) 545-7676

Specialties & licenses 1

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

Addresses

Primary practice location

877 Jefferson Ave
Memphis, TN 38103-2807

Mailing address

877 Jefferson Ave
Administration
Memphis, TN 38103-2807
Phone (901) 545-6265

Other identifiers 11

IdentifierTypeStateIssuer
0440152OtherTNOMNICARE
010159200MedicaidMO
01620772MedicaidKY
0440152MedicaidTN
107092105MedicaidAR
000000118296OtherTNBETTER HEALTH
1737119MedicaidLA
000491004XMedicaidGA
00020421MedicaidMS
1OtherTNTLC
9460OtherTNBC OF TN

Other names 1

  • Regional One Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050118000416 TN Part A Provider - Hospital 6608784855 Practice locations: Memphis, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144213117. Details of each certification follow.

Hospital certification: CCN 440152

Legal name
SHELBY COUNTY HEALTH CARE CORPORATION
Doing business as
REGIONAL ONE HEALTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1970
Last certification
Apr 24, 2007
Beds
631
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 1981 in TN
Enrollment address
877 Jefferson Ave
Memphis, TN 38103-2807
Main/Primary Hospital Location
Hospital subgroups
Acute care, Rehabilitation unit

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Regional One HealthCCN 440152 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Shelby County Healthcar9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

280 Sierra College Dr
Ste 115
Grass Valley, CA 95945
Phone (530) 477-3119

1220 Hemlock Way
Ste 203
Santa Ana, CA 92707
Phone (714) 850-2060

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Miska Clay-Bibbs Individual Corporate DirectorDirector Oct 2, 2023
Imad Abdullah Individual Corporate OfficerSVP/Chief Legal Officer/Gen Counsel Jan 1, 2018
Reginald Milton Individual Corporate DirectorDirector Oct 17, 2022
Franklin Dakin Individual Corporate DirectorDirector Jan 12, 2026
Timothy C Fabian Individual Corporate DirectorBoard Member Apr 2, 2018
Elizabeth Low Individual Corporate DirectorDirector Nov 18, 2024
Danielle Inez Crawford Individual Corporate DirectorDirector Nov 18, 2024
Raaj Kurapati Individual Corporate DirectorDirector Apr 14, 2025
Julia Kavanagh Individual Corporate DirectorDirector Jan 25, 2021
James Proctor Individual Corporate OfficerSVP/Chief Financial Officer Jul 1, 2021
W-2 Managing EmployeeSVP/Chief Financial Officer Jul 1, 2021
Reginald W Coopwood Individual Corporate OfficerChief Executive Officer Mar 10, 2010
W-2 Managing EmployeeChief Executive Officer Mar 10, 2010
Carl Carter Individual Corporate DirectorDirector Oct 17, 2022
Kevin Bradshaw Individual Corporate DirectorDirector Oct 17, 2022
Claudette Jones Shephard Individual Corporate DirectorDirector Jan 25, 2021
Ronald Coleman Individual Corporate Director May 31, 2016
Ephie Johnson Individual Corporate Director Jul 31, 2017

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Regional One Health Extended Care HospitalMemphis, TN, CCN 442017 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2013

Owned or controlled facilities with NPI records 1

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

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

Affiliated clinicians 403

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

View all 403

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1144213117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "address_2": "ADMINISTRATION",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-545-6265",
            "fax_number": "901-545-8194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-545-6265",
            "fax_number": "901-545-8194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY COUNTY HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-16",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "SVP/CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "901-545-7676"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMNICARE",
            "identifier": "0440152",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010159200",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01620772",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0440152",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107092105",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BETTER HEALTH",
            "identifier": "000000118296",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1737119",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000491004X",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020421",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TLC",
            "identifier": "1",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF TN",
            "identifier": "9460",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regional One Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Regional One Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.