NPIMap

Organization Active NPI

Geisinger Jersey Shore Hospital

  • Critical Access Hospital
  • Jersey Shore, PA
National Provider Identifier
1366407587
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
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
Apr 19, 2006
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 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
System Director Credenenrollments
Phone
(570) 271-6603

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Critical Access Hospital 282NC0060X 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
009912OtherFIRST PRIORITY HEALTH
5511OtherHEALTH AMERICA
10011OtherGEISINGER HEALTH PLAN
1007703560003MedicaidPA
59746OtherAETNA
391300OtherBLUE CROSS

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
Practice locations: Lock Haven, PA; Jersey Shore, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366407587. 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 with the same Medicare PAC ID 1

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: 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

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.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 110

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 110

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": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1366407587",
    "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": "2006-04-19",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "MULL",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR CREDENENROLLMENTS",
        "authorized_official_telephone_number": "570-271-6603"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "PA",
            "license": "101401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "009912",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "5511",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "10011",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007703560003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "59746",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "391300",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey Shore, PA

Sources for this page

Verify at the official NPI Registry.