NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Ballad Health Homecare

  • Home Health Agency
  • Johnson City, TN
National Provider Identifier
1417030404
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
269 Issued in TN
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Ballad Health Homecare
Practice address
509 Med Tech Pkwy Ste 200
Johnson City, TN 37604
Phone
(423) 431-6146
Fax
(423) 431-5288
NPI assigned
Oct 23, 2006
Last updated
Apr 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 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
Home Health Agency 251E00000X 269 TN Primary

Addresses

Primary practice location

509 Med Tech Pkwy Ste 200
Johnson City, TN 37604

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 431-6146

Other names 1

  • Ballad Health Homecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080530000203 TN Part A Provider - Home Health Agency 6002726718 Practice locations: Johnson City, TN
O20110623000585 TN Part B Supplier - Independent Clinical Laboratory 6002726718 Practice locations: Johnson City, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417030404. Details of each certification follow.

Home health agency certification: CCN 447240

Legal name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
BALLAD HEALTH HOMECARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 7, 1983
Last certification
Jun 28, 2007
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1945 in TN
Enrollment address
509 Med Tech Pkwy
Ste 200
Johnson City, TN 37604-2579

Other NPIs with the same Medicare PAC ID 20

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

View all 20

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ballad Health HomecareCCN 447240 · All quality measures
Overall star rating
4.5 of 5
Ownership
Non-Profit
Certified
Dec 7, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Member of 1

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

Locations

101 Med Tech Pkwy
Ste 102
Johnson City, TN 37604
Phone (423) 431-7626

509 Med Tech Pkwy
Ste 200
Johnson City, TN 37604
Phone (423) 431-6146

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
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
Mountain States Health Alliance Organization, Johnson City, TN Non-profit 5% Or Greater Direct Ownership Interest Jan 8, 2007 100%
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 20

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

View all 20

All facility ownership & control disclosures 25

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

FacilityTypeRoleSince
Smyth County Community HospitalMarion, VA, CCN 490038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Rehabilitation Hospital of Kingsport, a Joint Venture of Ballad HealthKingsport, TN, CCN 443027 Hospital 5% Or Greater Indirect Ownership Interest (11%) Jan 1, 2021
Woodridge HospitalJohnson City, TN, CCN 44S063 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2005
Johnston Memorial Hospital IncAbingdon, VA, CCN 490053 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Smyth County Swing Bed UnitMarion, VA, CCN 49U038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Russell County HospitalLebanon, VA, CCN 490002 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2008
Russell County HospitalLebanon, VA, CCN 49U002 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2008
Sycamore Shoals HospitalElizabethton, TN, CCN 440018 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1998
Rehabilitation Hospital of Bristol, a Joint Venture of Ballad Health aBristol, VA, CCN 493034 Hospital 5% Or Greater Indirect Ownership Interest (25%) Nov 1, 2021
Southwest Virginia Inpatient RehabMarion, VA, CCN 49T038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2021
Quillen Rehabilitation Hospital, a JV of Ballad Health and EncompassJohnson City, TN, CCN 443033 Hospital 5% Or Greater Indirect Ownership Interest (49.9%) Sep 30, 2014
Lee County Community HospitalPennington Gap, VA, CCN 491309 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Princeton Transitional Care and Assisted LivingJohnson City, TN, CCN 445356 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (100%) Dec 3, 2018
Wexford HouseKingsport, TN, CCN 445207 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (5%)		 May 1, 2025
May 1, 2025
Laughlin Healthcare CenterGreeneville, TN, CCN 445264 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (5%)		 May 1, 2025
May 1, 2025
Francis Marion Manor Health & RehabilitationMarion, VA, CCN 495384 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest (5%)		 May 1, 2025
May 1, 2025
Ballad Health HomecareAbingdon, VA, CCN 497492A Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2018
Ballad Health HomecareGreeneville, TN, CCN 447428 Home health agency 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
Ballad Health HomecareNorton, VA, CCN 497068 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2020
Ballad Health HospiceBristol, TN, CCN 441558 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2018
Ballad Health HospiceAbingdon, VA, CCN 491542 Hospice 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2018
Bhrhc MtncityMountain City, TN, CCN 443438 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 13, 2001
Bhrhc GladeGlade Spring, VA, CCN 493981 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 10, 2021
Bhrhc StpaulSaint Paul, VA, CCN 493978 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2008
Bhrhc LebanonLebanon, VA, CCN 493423 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 7, 2016

Owned or controlled facilities with NPI records 27

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

View all 27

Facilities with the same owner 41

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

View all 41

Practitioners & affiliated clinicians

Affiliated clinicians 51

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

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1417030404",
    "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": "423-431-6146",
            "fax_number": "423-431-5288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MED TECH PKWY STE 200",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-431-6146",
            "fax_number": "423-431-5288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "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": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TN",
            "license": "269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballad Health Homecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.