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Organization Active NPI

Dickenson Community Hospital, Inc

Doing business as Dickenson Community Hospital Psychiatric Unit

  • Psychiatric Hospital Unit
  • Clintwood, VA
National Provider Identifier
1376933580
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
0000000119 Issued in VA
Legal business name
DICKENSON COMMUNITY HOSPITAL, INC
Doing business as
Dickenson Community Hospital Psychiatric Unit
Practice address
312 Hospital Dr
Clintwood, VA 24228-6786
Phone
(276) 926-0251
Fax
(276) 926-0329
NPI assigned
Jan 26, 2015
Last updated
Apr 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 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
Psychiatric Hospital Unit 273R00000X 0000000119 VA Primary

Addresses

Primary practice location

312 Hospital Dr
Clintwood, VA 24228-6786

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (276) 926-0251

Other names 1

  • Dickenson Community Hospital Psychiatric Unit Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other Dickenson Community Hospital, Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230106001782 VA Part A Provider - Critical Access Hospital 8921096561 Practice locations: Clintwood, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376933580. Details of each certification follow.

Hospital certification: CCN 49M303

Legal name
DICKENSON COMMUNITY HOSPITAL, INC.
Doing business as
DICKENSON COMMUNITY HOSPITAL PSYCHIATRIC UNIT
Organization structure
CorporationNon-profit
Incorporated
May 30, 2003 in VA
Enrollment address
312 Hospital Dr
Clintwood, VA 24228-6786
Hospital Psychiatric Unit

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Member of 1

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

Locations

364 Hospital Dr
Clintwood, VA 24228
Phone (276) 926-0200

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
Gregory Wilgocki Individual Corporate DirectorSVP Feb 1, 2018
W-2 Managing EmployeeSVP Feb 1, 2018
Wellmont Health System Organization, Kingsport, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 28, 2021 100%
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
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 9

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

Facilities with the same owner 40

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

View all 40

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1376933580",
    "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": "276-926-0251",
            "fax_number": "276-926-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 HOSPITAL DR",
            "city": "CLINTWOOD",
            "state": "VA",
            "postal_code": "242286786",
            "telephone_number": "276-926-0251",
            "fax_number": "276-926-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKENSON COMMUNITY HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "VA",
            "license": "0000000119",
            "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": "Dickenson Community Hospital, Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "312 Hospital Dr",
            "city": "Clintwood",
            "state": "VA",
            "country_code": "US",
            "postal_code": "242286786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dickenson Community Hospital Psychiatric Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clintwood, VA

Sources for this page

Verify at the official NPI Registry.