NPIMap

Organization Active NPI

Wellmont Health System

Doing business as Holston Valley Medical Center

  • General Acute Care Hospital
  • Kingsport, TN
National Provider Identifier
1487690400
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
WELLMONT HEALTH SYSTEM
Doing business as
Holston Valley Medical Center
Practice address
130 W Ravine Rd
Kingsport, TN 37660
Phone
(423) 224-4000
NPI assigned
Jun 20, 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
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

130 W Ravine Rd
Kingsport, TN 37660

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 224-4000

Other identifiers 18

IdentifierTypeStateIssuer
1000805OtherTNTN BLUE CROSS
4400017MedicaidNC
0039632OtherTNUMWA IN-PATIENT
004400178MedicaidVA
092263300MedicaidFL
6530375OtherTNAETNA
0440017MedicaidTN
166592401OtherTNPOSTAL WORKERS DEPT OF LA
036101100OtherTNBLACK LUNG
100020304MedicaidTN
0039640OtherTNUMWA OUT-PATIENT
0169767000MedicaidWV
A3766001OtherTNUHC RIVER VALLEY
1000805MedicaidTN
0162200000MedicaidKY
1741825MedicaidLA
240866OtherVAANTHEM BLUE CROSS
A3766001MedicaidTN

Other names 1

  • HOLSTON VALLEY MEDICAL CENTER Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other WELLMONT HEALTH SYSTEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031223000853 TN Part B Supplier - Clinic/Group Practice 2567360704 Receives reassigned benefits from 4 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bristol, TN; Kingsport, TN; Sneedville, TN
O20040608001167 TN Part A Provider - Hospital 2567360704 Practice locations: Kingsport, TN
O20161221000485 TN Part B Supplier - Intensive Cardiac Rehabilitation 2567360704 Practice locations: Kingsport, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487690400. Details of each certification follow.

Hospital certification: CCN 440017

Legal name
WELLMONT HEALTH SYSTEM
Doing business as
HOLSTON VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 20, 2011
Beds
505
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1996 in TN
Enrollment address
130 W Ravine Rd
Kingsport, TN 37660-3810
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Wellmont Holston Valley Medical CenterCCN 440017 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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
Corporate DirectorEvp/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, Chain home office 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

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
Hawkins County Memorial HospitalRogersville, TN, CCN 440032 Hospital 5% Or Greater Indirect Ownership Interest (100%) Apr 6, 2000
Bristol Regional Medical CenterBristol, TN, CCN 440012 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1996
Lonesome Pine HospitalBig Stone Gap, VA, CCN 490114 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2007
Lonesome Pine Hospital Swing Bed UnitBig Stone Gap, VA, CCN 49U114 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 19, 2007
Dickenson Community Hospital, Inc.Clintwood, VA, CCN 491303 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2021
Greeneville Community HospitalGreeneville, TN, CCN 440050 Hospital 5% Or Greater Indirect Ownership Interest (100%) Dec 8, 2016
Norton Community Rehabilitaion UnitNorton, VA, CCN 49T114 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2007
Dickenson Community Hospital Psychiatric UnitClintwood, VA, CCN 49M303 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2021
Norton Community Hospital SNF UnitNorton, VA, CCN 495374 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Aug 1, 2007
Apr 1, 2004
Bhrhc DickensonClintwood, VA, CCN 493463 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2021

Owned or controlled facilities with NPI records 10

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

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 20

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 20

Affiliated clinicians 941

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

View all 941

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1487690400",
    "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": "423-224-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37660",
            "telephone_number": "423-224-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN BLUE CROSS",
            "identifier": "1000805",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4400017",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA IN-PATIENT",
            "identifier": "0039632",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004400178",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092263300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6530375",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0440017",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "POSTAL WORKERS DEPT OF LA",
            "identifier": "166592401",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "036101100",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100020304",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA OUT-PATIENT",
            "identifier": "0039640",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0169767000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC RIVER VALLEY",
            "identifier": "A3766001",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000805",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0162200000",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1741825",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "240866",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A3766001",
            "state": "TN"
        }
    ],
    "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": "WELLMONT HEALTH SYSTEM",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "130 W Ravine Rd",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "37660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "HOLSTON VALLEY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HOLSTON VALLEY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.