NPIMap

Organization Active NPI

Hospice of Surry County, Inc

Doing business as Mountain Valley

  • Community Based Hospice Care Agency
  • Galax, VA
National Provider Identifier
1346422847
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HSP-06123 Issued in VA
Legal business name
HOSPICE OF SURRY COUNTY, INC
Doing business as
Mountain Valley
Mountain Valley Hospice and Palliative Care
Practice address
7599 Carrollton Pike Ste C
Galax, VA 24333-4269
Phone
(276) 728-1030
Fax
(276) 728-1041
NPI assigned
Nov 27, 2007
Last updated
Aug 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Mrs. Tracey Smith Dobson, RN, BSN
Title
Interim Ceo
Phone
(336) 789-2922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HSP-06123 VA Primary

Addresses

Primary practice location

7599 Carrollton Pike Ste C
Galax, VA 24333-4269

Mailing address

PO Box 325
Dobson, NC 27017-0325
Phone (336) 789-2922

Other practice location 1

730 E Church St Ste 13
Martinsville, VA 24112-3151
Phone (276) 403-4764

Other identifiers 1

IdentifierTypeStateIssuer
010254281MedicaidVA

Other names 2

  • Mountain Valley Doing business as
  • Mountain Valley Hospice and Palliative Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080207000020 VA Part A Provider - Hospice 2961448741 Practice locations: Galax, VA; Martinsville, VA
O20081007000249 VA Part B Supplier - Clinic/Group Practice 2961448741 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galax, VA; Martinsville, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346422847. Details of each certification follow.

Hospice certification: CCN 491580

Legal name
HOSPICE OF SURRY COUNTY INC
Doing business as
MOUNTAIN VALLEY HOSPICE & PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 15, 2005
Last certification
Sep 15, 2011
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Nov 8, 1982 in NC
Enrollment address
7599 Carrollton Pike
# C
Galax, VA 24333-4269

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 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Mountain Valley Hospice & Palliative CareCCN 491580 · All quality measures
Ownership
Non-Profit
Certified
Dec 15, 2005
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 2

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

Locations

105 N Crutchfield St
#2
Dobson, NC 27017
Phone (336) 789-2922

1427 Edgewood Dr
Mount Airy, NC 27030
Phone (336) 789-2922

243 N Lee Ave
Yadkinville, NC 27055
Phone (336) 677-1692

516 Hawthorne Dr
Yadkinville, NC 27055

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Northern Hospital of Surry County Organization, Mount Airy, NC 5% Or Greater Direct Ownership Interest Oct 1, 2005 50%
Barry S Dowell Individual Corporate OfficerCfo Oct 23, 2017
W-2 Managing EmployeeCfo Oct 23, 2017
Hugh Chatham Memorial Hospital Inc Organization, Elkin, NC Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2005 50%
Tracey Smith Dobson Individual Corporate OfficerInterim Ceo May 20, 2020
Corporate DirectorInterim Ceo May 20, 2020
W-2 Managing EmployeeInterim Ceo May 20, 2020
Tara Dowell Individual W-2 Managing Employee Jun 26, 2007

Owners & managing parties with NPI records 12

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
Mountain ValleyFort Mill, SC, CCN 421654 Hospice 5% Or Greater Indirect Ownership Interest (8%) Dec 11, 2024

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1346422847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 325",
            "city": "DOBSON",
            "state": "NC",
            "postal_code": "270170325",
            "telephone_number": "336-789-2922",
            "fax_number": "336-789-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7599 CARROLLTON PIKE STE C",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243334269",
            "telephone_number": "276-728-1030",
            "fax_number": "276-728-1041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "730 E Church St Ste 13",
            "address_purpose": "LOCATION",
            "city": "Martinsville",
            "state": "VA",
            "postal_code": "241123151",
            "country_code": "US",
            "telephone_number": "276-403-4764",
            "fax_number": "276-403-4600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOSPICE OF SURRY COUNTY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "DOBSON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "SMITH",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "336-789-2922",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "VA",
            "license": "HSP-06123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010254281",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Valley",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Valley Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Valley Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galax, VA

Sources for this page

Verify at the official NPI Registry.