Mountain States Health Alliance
Organization Active NPI Home Health Agency · Johnson City, TN
NPI 1417030404 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1417030404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 269 (TN)
- Legal business name
- MOUNTAIN STATES HEALTH ALLIANCE
- 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
- Organization subpart
- No
Authorized official
- Name
- Shane Edwin Hilton
- Title
- Evp/Cfo
- Phone
- (423) 302-3467
Owners & managing parties with NPI records 20
Owned or controlled facilities with NPI records 27
Other NPIs with the same Medicare PAC ID 20
Facilities with the same owner 41
Practitioners 23
-
Jamie E Carnell, NP
-
Dennis Charles Desimone, D.O.
-
Holly Ann Fisk, FNP-C
-
Christopher R. Gabler, P.A.-C.
-
Johanna Galyen, FNP-C
-
Danielle S Giles, NP
-
Deborah J Hassebrock, FNP
-
Ruth D Johnson, MSN
-
Jamie G McNutt, FNP
-
Suzan Page, N.P.
-
Sakshi Singal, M.D.
-
Lindsey Debord Yoggerst, FNP-BC
-
Bradley Wayne Beeler, M.D.
-
Candice M Bolling, P.A.-C
-
Emily Brooke Crabtree, FNP-C
-
Steven Lester, PMHNP
-
Matthew Rendo, M.D.
-
Laura Marie Walts, M.A., LPC
Affiliated clinicians 51
-
Benedict E Aimua, MD
-
Stacey Lynn Collins, APN
-
Keith R Cook, MD
-
Sergio A Diaz, MD
-
Holly Dillon Dockery, DNP, AGPCNP-BC, RN
-
Aaron M Doran, DO
-
Matthew Daniel Garrison, M.D.
-
James A Goss, M.D.
-
Kasi Griffin, MD
-
Eric J Groen, DO
-
James W Hansen, MD
-
Rachel A Hearn, FNP-C
-
Katherine J Hodge, D.O.
-
Randy W Hoover, MD
-
Todd Horton, MD
-
Steven Dylan Hubbard, FNP-C
-
Sharjeel Iqbal, MD
-
Patrick K Jones, D.O.
-
Brandon D Ketron, DO
Medicare Care Compare: Home health agency
- Listed as
- Ballad Health Homecare
- Overall star rating
- ★★★★★ 4.5 of 5
- Ownership
- Non-Profit
- Certified
- Dec 7, 1983
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
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
- Corporation · Non-profit
- Incorporated
- Apr 12, 1945 in TN
- Enrollment address
- 509 Med Tech Pkwy
Ste 200
Johnson City, TN 37604-2579
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Shane Hilton |
Corporate Officer |
Apr 4, 2024 | |
| Gregory Wilgocki |
Corporate Director |
Feb 1, 2018 | |
| W-2 Managing Employee |
Feb 1, 2018 | ||
| Ballad Health |
5% Or Greater Indirect Ownership Interest | Feb 1, 2018 | 100% |
| Marvin Eichorn |
Corporate Officer |
Feb 1, 2018 | |
| Corporate Director |
Feb 1, 2018 | ||
| Mountain States Health Alliance |
5% Or Greater Direct Ownership Interest | Jan 8, 2007 | 100% |
| Buford Deaton |
Corporate Officer |
Feb 1, 2018 | |
| Corporate Director |
Feb 1, 2018 | ||
| Alan Levine |
Corporate Officer |
Feb 1, 2018 | |
| Corporate Director |
Feb 1, 2018 | ||
| Julie Bennett |
Corporate Officer |
Feb 1, 2023 | |
| Corporate Director |
Feb 1, 2023 |
All facility ownership & control disclosures 25
| Facility | Type | Role | Since |
|---|---|---|---|
| Smyth County Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Rehabilitation Hospital of Kingsport, a Joint Venture of Ballad Health |
Hospital | 5% Or Greater Indirect Ownership Interest (11%) | Jan 1, 2021 |
| Woodridge Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2005 |
| Johnston Memorial Hospital Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Smyth County Swing Bed Unit |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Russell County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2008 |
| Russell County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2008 |
| Sycamore Shoals Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 1998 |
| Rehabilitation Hospital of Bristol, a Joint Venture of Ballad Health a |
Hospital | 5% Or Greater Indirect Ownership Interest (25%) | Nov 1, 2021 |
| Southwest Virginia Inpatient Rehab |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Quillen Rehabilitation Hospital, a JV of Ballad Health and Encompass |
Hospital | 5% Or Greater Indirect Ownership Interest (49.9%) | Sep 30, 2014 |
| Lee County Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2021 |
| Princeton Transitional Care and Assisted Living |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest (100%) | Dec 3, 2018 |
| Wexford House |
Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (5%) |
May 1, 2025 May 1, 2025 |
| Laughlin Healthcare Center |
Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (5%) |
May 1, 2025 May 1, 2025 |
| Francis Marion Manor Health & Rehabilitation |
Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (5%) |
May 1, 2025 May 1, 2025 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2020 |
| Ballad Health Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Ballad Health Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Bhrhc Mtncity |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 13, 2001 |
| Bhrhc Glade |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Nov 10, 2021 |
| Bhrhc Stpaul |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2008 |
| Bhrhc Lebanon |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 7, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 269 | TN | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4149709 | Other | TN | BLUE CROSS |
| 447240 | Medicaid | TN |
Other names
- Ballad Health Homecare
Other providers in Johnson City, TN
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
All providers in Johnson City, TN · Home Health Agency in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.