NPIMap

Organization Active NPI

Geisinger Jersey Shore Hospital

  • Clinic/Center
  • Lock Haven, PA
National Provider Identifier
1275128381
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GEISINGER JERSEY SHORE HOSPITAL
Practice address
68 Spring Street
Lock Haven, PA 17745-1911
Phone
(800) 230-4565
Fax
(570) 893-6325
NPI assigned
Mar 2, 2021
Last updated
Sep 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GEISINGER JERSEY SHORE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Authorized official

Name
Cindy L Mull
Title
Credentialing & Enrollment Director
Phone
(570) 271-6603

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

68 Spring Street
Lock Haven, PA 17745-1911

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000518 PA Part A Provider - Critical Access Hospital 7517954209 Receives reassigned benefits from 59 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lock Haven, PA; Jersey Shore, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275128381. Details of each certification follow.

Hospital certification: CCN 391300

Legal name
GEISINGER JERSEY SHORE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2001
Last certification
Nov 9, 2023
Beds
25 (21 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 1922 in PA
Enrollment address
1020 Thompson St
Jersey Shore, PA 17740-1794

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Geisinger Jersey Shore HospitalCCN 391300 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Jersey Shore Hosp Lab3 organizations share this tax ID, including this one
Part of
Jersey Shore Hosp Lab

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the 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
Ronald Beer Individual Corporate Director Mar 1, 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

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 153

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

View all 153

NPI Registry JSON

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

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1275128381",
    "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": "68 SPRING STREET",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "177451911",
            "telephone_number": "800-230-4565",
            "fax_number": "570-893-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEISINGER JERSEY SHORE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEISINGER JERSEY SHORE HOSPITAL",
        "enumeration_date": "2021-03-02",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "MULL",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING & ENROLLMENT DIRECTOR",
        "authorized_official_telephone_number": "570-271-6603"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lock Haven, PA

Sources for this page

Verify at the official NPI Registry.