NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Bhrhc Lebanon

  • Rural Health Clinic/Center
  • Lebanon, VA
National Provider Identifier
1245772664
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Bhrhc Lebanon
Practice address
344 Overlook Dr Ste 100
Lebanon, VA 24266-3436
Phone
(276) 883-8042
Fax
(276) 883-8044
NPI assigned
Nov 16, 2016
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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

344 Overlook Dr Ste 100
Lebanon, VA 24266-3436

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (276) 883-8042

Other names 1

  • BHRHC LEBANON Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other Mountain States Health Alliance

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170810000781 VA Part A Provider - Rural Health Clinic 6002726718 Practice locations: Lebanon, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245772664. Details of each certification follow.

Rural health clinic certification: CCN 493423

Legal name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
BHRHC LEBANON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 5, 2017
Last certification
Jun 28, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1945 in VA
Enrollment address
344 Overlook Dr
Ste 100
Lebanon, VA 24266-3436
Related CCNs
490002

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

Other NPIs with the same Medicare PAC ID 20

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

View all 20

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
49D2122330Bhrhc Lebanon344 Overlook Drve Suite 100, Lebanon, VA 24266Certificate of waiverNov 27, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Psychia41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

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 7, 2016 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 20

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

View all 20

All facility ownership & control disclosures 25

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

FacilityTypeRoleSince
Smyth County Community HospitalMarion, VA, CCN 490038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Rehabilitation Hospital of Kingsport, a Joint Venture of Ballad HealthKingsport, TN, CCN 443027 Hospital 5% Or Greater Indirect Ownership Interest (11%) Jan 1, 2021
Woodridge HospitalJohnson City, TN, CCN 44S063 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2005
Johnston Memorial Hospital IncAbingdon, VA, CCN 490053 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Smyth County Swing Bed UnitMarion, VA, CCN 49U038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Russell County HospitalLebanon, VA, CCN 490002 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2008
Russell County HospitalLebanon, VA, CCN 49U002 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2008
Sycamore Shoals HospitalElizabethton, TN, CCN 440018 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1998
Rehabilitation Hospital of Bristol, a Joint Venture of Ballad Health aBristol, VA, CCN 493034 Hospital 5% Or Greater Indirect Ownership Interest (25%) Nov 1, 2021
Southwest Virginia Inpatient RehabMarion, VA, CCN 49T038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Quillen Rehabilitation Hospital, a JV of Ballad Health and EncompassJohnson City, TN, CCN 443033 Hospital 5% Or Greater Indirect Ownership Interest (49.9%) Sep 30, 2014
Lee County Community HospitalPennington Gap, VA, CCN 491309 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Princeton Transitional Care and Assisted LivingJohnson City, TN, CCN 445356 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (100%) Dec 3, 2018
Wexford HouseKingsport, TN, CCN 445207 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (5%)		 May 1, 2025
May 1, 2025
Laughlin Healthcare CenterGreeneville, TN, CCN 445264 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (5%)		 May 1, 2025
May 1, 2025
Francis Marion Manor Health & RehabilitationMarion, VA, CCN 495384 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (5%)		 May 1, 2025
May 1, 2025
Ballad Health HomecareJohnson City, TN, CCN 447240 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jan 8, 2007
Ballad Health HomecareAbingdon, VA, CCN 497492A Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2018
Ballad Health HomecareGreeneville, TN, CCN 447428 Home health agency 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Ballad Health HomecareNorton, VA, CCN 497068 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2020
Ballad Health HospiceBristol, TN, CCN 441558 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2018
Ballad Health HospiceAbingdon, VA, CCN 491542 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2018
Bhrhc MtncityMountain City, TN, CCN 443438 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 13, 2001
Bhrhc GladeGlade Spring, VA, CCN 493981 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 10, 2021
Bhrhc StpaulSaint Paul, VA, CCN 493978 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2008

Owned or controlled facilities with NPI records 27

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

View all 27

Facilities with the same owner 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1245772664",
    "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": "276-883-8042",
            "fax_number": "276-883-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 OVERLOOK DR STE 100",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242663436",
            "telephone_number": "276-883-8042",
            "fax_number": "276-883-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-16",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": "Mountain States Health Alliance",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "344 Overlook Dr Ste 100",
            "city": "Lebanon",
            "state": "VA",
            "country_code": "US",
            "postal_code": "242663436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BHRHC LEBANON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, VA

Sources for this page

Verify at the official NPI Registry.