NPIMap

Organization Active NPI

Charles a Cannon Jr Memorial Hospital, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Linville, NC
National Provider Identifier
1376611574
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H0037 Issued in NC
Legal business name
CHARLES A CANNON JR MEMORIAL HOSPITAL, INC.
Practice address
434 Hospital Drive
Linville, NC 28646-0787
Phone
(828) 737-7000
Fax
(828) 737-7034
NPI assigned
Dec 4, 2006
Last updated
Jan 15, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
APPALACHIAN REGIONAL HEALTHCARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Authorized official

Name
Mrs. Mary Etta Long
Title
Sr VP Medical Staff Relations
Phone
(828) 261-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H0037 NC Primary

Addresses

Primary practice location

434 Hospital Drive
Linville, NC 28646-0787

Mailing address

PO Box 787
Linville, NC 28646-0787
Phone (828) 737-7000

Other identifiers 4

IdentifierTypeStateIssuer
0080COtherNCNC BLUE CROSS SWB PROV #
3461323MedicaidNC
152168200OtherNCOWCP SWB PROV NUMBER
5070877OtherNCUNITED HEALTHCARE SWINGBE

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220906001184 NC Part A Provider - Critical Access Hospital 3274426952 Practice locations: Linville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376611574. Details of each certification follow.

Hospital certification: CCN 34Z323

Legal name
CHARLES A CANNON JR MEMORIAL HOSPITAL INC
Doing business as
CANNON MEMORIAL HOSPITAL
Organization structure
CorporationProprietary
Enrollment address
434 Hospital Dr
Linville, NC 28646-0787
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 4

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 8

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

NameRoleSinceShare
Appalachian Regional Healthcare System Inc Organization, Boone, NC 5% Or Greater Direct Ownership Interest Jun 1, 2004
David Nipper Individual Corporate OfficerCeo Jan 1, 2025
W-2 Managing EmployeeAd; Jan 1, 2025
John Peter Lewis Individual Corporate OfficerUnc Health Chief Business Integrati Jul 1, 2022
University of North Carolina Health Care System Organization, Linville, NC Operational/Managerial Control Jul 1, 2022
Stephanie Greer Individual W-2 Managing EmployeePresident Avery Market Oct 1, 2021
Mary Long Individual W-2 Managing EmployeeSr VP Medical Staff Relations Apr 18, 2013
Richard Lee Cassady Individual Corporate OfficerCfo Nov 28, 2022
Allee Hollars Individual W-2 Managing EmployeeMedical Staff Relations Sep 3, 2013

Owners & managing parties with NPI records 3

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

Facilities with the same owner 43

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

View all 43

Practitioners & affiliated clinicians

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": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1376611574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 787",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460787",
            "telephone_number": "828-737-7000",
            "fax_number": "828-737-7034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 HOSPITAL DRIVE",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460787",
            "telephone_number": "828-737-7000",
            "fax_number": "828-737-7034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A CANNON JR MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "APPALACHIAN REGIONAL HEALTHCARE SYSTEM",
        "enumeration_date": "2006-12-04",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ETTA",
        "authorized_official_title_or_position": "SR VP MEDICAL STAFF RELATIONS",
        "authorized_official_telephone_number": "828-261-4133",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NC",
            "license": "H0037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BLUE CROSS SWB PROV #",
            "identifier": "0080C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3461323",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP SWB PROV NUMBER",
            "identifier": "152168200",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE SWINGBE",
            "identifier": "5070877",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Linville, NC

Sources for this page

Verify at the official NPI Registry.