NPIMap

Organization Active NPI

Geisinger Jersey Shore Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Jersey Shore, PA
National Provider Identifier
1215970223
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
101401 Issued in PA
Legal business name
GEISINGER JERSEY SHORE HOSPITAL
Practice address
1020 Thompson St
Jersey Shore, PA 17740-1729
Phone
(570) 398-0100
Fax
(570) 398-4412
NPI assigned
Jun 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Authorized official

Name
Cindy L Mull
Title
System Director Enrollments
Phone
(570) 271-6603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 101401 PA Primary

Addresses

Primary practice location

1020 Thompson St
Jersey Shore, PA 17740-1729

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 6

IdentifierTypeStateIssuer
39Z300OtherPARAILROAD MEDICARE
009912OtherPAFIRST PRIORITY
5511OtherPAHEALTH AMERICA
10011OtherPAGEISINGER
391300OtherPAWORKERS COMPENSATION
39Z300OtherPABLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220807000032 PA Part A Provider - Critical Access Hospital 7517954209 Practice locations: Jersey Shore, PA

Hospital certification: CCN 39Z300

Legal name
GEISINGER JERSEY SHORE HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
1020 Thompson St
Jersey Shore, PA 17740-1729
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Terry Gilliland Individual Corporate Officer May 6, 2024
Cindy Mull Individual W-2 Managing EmployeeSystem Director Credentialing Jan 1, 2018
Jeffrey a Jacobson Individual Corporate Director Mar 1, 2019
Chris Holcombe Individual Corporate Director Jan 1, 2018
Benjamin K Chu Individual Corporate Director Jan 1, 2020
Jersey Shore Hospital Foundation, Inc Organization, Jersey Shore, PA Corporation 5% Or Greater Direct Ownership Interest Aug 17, 1989
Gerald V Maloney Individual Corporate Director Mar 1, 2019
Virginia McGregor Individual Corporate Director Jan 1, 2018
Megan Brosious Individual Corporate Officer Mar 1, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1215970223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 THOMPSON ST",
            "city": "JERSEY SHORE",
            "state": "PA",
            "postal_code": "177401729",
            "telephone_number": "570-398-0100",
            "fax_number": "570-398-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEISINGER JERSEY SHORE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "MULL",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR ENROLLMENTS",
        "authorized_official_telephone_number": "570-271-6603"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "PA",
            "license": "101401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "39Z300",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "009912",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "5511",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER",
            "identifier": "10011",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "391300",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "39Z300",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey Shore, PA

Sources for this page

Verify at the official NPI Registry.