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Organization Active NPI

Shenandoah Memorial Hospital, Inc.

  • Surgery Physician
  • Woodstock, VA
National Provider Identifier
1407357015
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SHENANDOAH MEMORIAL HOSPITAL, INC.
Practice address
759 S Main St
Woodstock, VA 22664-1154
Phone
(540) 459-1100
NPI assigned
Feb 28, 2018
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
SHENANDOAH MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Renee Nevada Johnson
Title
Credentialing Coordinator
Phone
(540) 536-0103

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X VA
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X VA
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X VA
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X VA
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X VA Primary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X VA
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X VA

Addresses

Primary practice location

759 S Main St
Woodstock, VA 22664-1154

Mailing address

220 Campus Blvd Ste 200
Winchester, VA 22601-2889

Other practice location 1

200 Memorial Dr
Luray, VA 22835-1000
Phone (540) 743-4561

Other practice location 2

1000 N Shenandoah Ave
Front Royal, VA 22630-3547
Phone (540) 636-0300

Other practice location 3

1840 Amherst St
Winchester, VA 22601-2808
Phone (540) 536-8000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180430001662 VA Part B Supplier - Clinic/Group Practice 2466360375 Receives reassigned benefits from 61 practitioners
Practice locations: Woodstock, VA

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Part of
Mountain View Ortho

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Valley Health Shenandoah Memorial Hospital PediatricsWoodstock, VA, CCN 493426 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Shenandoah Memorial Hospital, Inc.Woodstock, VA, CCN 493427 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Valley Health Shenandoah Memorial Hospital Multispecialty ClinicNew Market, VA, CCN 493424 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Valley Health Primary Care StrasburgStrasburg, VA, CCN 493435 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 348

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 348

NPI Registry JSON

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1407357015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CAMPUS BLVD STE 200",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "759 S MAIN ST",
            "city": "WOODSTOCK",
            "state": "VA",
            "postal_code": "226641154",
            "telephone_number": "540-459-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Luray",
            "state": "VA",
            "postal_code": "228351000",
            "country_code": "US",
            "telephone_number": "540-743-4561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 N Shenandoah Ave",
            "address_purpose": "LOCATION",
            "city": "Front Royal",
            "state": "VA",
            "postal_code": "226303547",
            "country_code": "US",
            "telephone_number": "540-636-0300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1840 Amherst St",
            "address_purpose": "LOCATION",
            "city": "Winchester",
            "state": "VA",
            "postal_code": "226012808",
            "country_code": "US",
            "telephone_number": "540-536-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHENANDOAH MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHENANDOAH MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2018-02-28",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "NEVADA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "540-536-0103"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "VA",
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, VA

Sources for this page

Verify at the official NPI Registry.