NPIMap

Organization Active NPI

Smyth County Community Hospital

Doing business as Bhrhc Glade

  • Rural Health Clinic/Center
  • Glade Spring, VA
National Provider Identifier
1174529242
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H1902 Issued in VA
Legal business name
SMYTH COUNTY COMMUNITY HOSPITAL
Doing business as
Bhrhc Glade
Practice address
636 S Monte Vista Dr
Glade Spring, VA 24340-2712
Phone
(276) 429-5163
Fax
(276) 429-5515
NPI assigned
Jun 23, 2005
Last updated
Apr 16, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SMYTH COUNTY COMMUNITY HOSPITALAs reported in NPPES

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
Rural Health Clinic/Center 261QR1300X H1902 VA Primary

Addresses

Primary practice location

636 S Monte Vista Dr
Glade Spring, VA 24340-2712

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (276) 429-5163

Other identifiers 1

IdentifierTypeStateIssuer
007610131MedicaidVA

Other names 1

  • BHRHC GLADE Doing business as

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 VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031229000522 VA Part B Supplier - Clinic/Group Practice 0446168496 Receives reassigned benefits from 5 practitioners
10 other NPIs on this enrollment
Practice locations: Glade Spring, VA
O20061213000366 VA Part A Provider - Rural Health Clinic 0446168496 Practice locations: Glade Spring, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174529242. Details of each certification follow.

Rural health clinic certification: CCN 493981

Legal name
SMYTH COUNTY COMMUNITY HOSPITAL
Doing business as
BHRHC GLADE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 2, 1995
Last certification
Jul 1, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1961 in VA
Enrollment address
636 S Monte Vista Dr
Glade Spring, VA 24340-2712
Related CCNs
490038

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 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0687929Bhrhc Glade636 S Monte Vista Drive, Glade Spring, VA 24340Provider-performed microscopyJan 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Smyth County Community GRP5 organizations share this tax ID, including this one
Part of
Smyth County Community GRP

Other organizations with this tax ID 4

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

Member of 1

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

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
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

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1174529242",
    "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": "276-429-5163",
            "fax_number": "276-429-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 S MONTE VISTA DR",
            "city": "GLADE SPRING",
            "state": "VA",
            "postal_code": "243402712",
            "telephone_number": "276-429-5163",
            "fax_number": "276-429-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMYTH COUNTY COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMYTH COUNTY COMMUNITY HOSPITAL",
        "enumeration_date": "2005-06-23",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "VA",
            "license": "H1902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007610131",
            "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": "636 S Monte Vista Dr",
            "city": "Glade Spring",
            "state": "VA",
            "country_code": "US",
            "postal_code": "243402712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BHRHC GLADE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glade Spring, VA

Sources for this page

Verify at the official NPI Registry.