NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Johnson County Community Hospital

  • Critical Access Hospital
  • Mountain City, TN
National Provider Identifier
1497859789
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0000000038 Issued in TN
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Johnson County Community Hospital
Practice address
1901 S Shady St
Mountain City, TN 37683-2021
Phone
(423) 727-1100
Fax
(423) 727-1112
NPI assigned
Sep 8, 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
Critical Access Hospital 282NC0060X 0000000038 TN Primary

Addresses

Primary practice location

1901 S Shady St
Mountain City, TN 37683-2021

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 727-1100

Other identifiers 12

IdentifierTypeStateIssuer
3810001915MedicaidWV
4001915OtherBLUE CROSS
0441304MedicaidTN
4401304MedicaidNC
091618800MedicaidFL
93633835AMedicaidGA
100020317OtherPHP
004413041MedicaidVA
11500BMedicaidSC
2669036OtherCIGNA
4001915OtherANTHEM
A3768308OtherJOHN DEERE

Other names 1

  • Johnson County Community Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other Mountain States Health Alliance

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061113000477 TN Part A Provider - Hospital 6002726718 Practice locations: Mountain City, TN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1497859789. Details of each certification follow.

Hospital certification: CCN 441304

Legal name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
JOHNSON COUNTY COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 13, 2001
Last certification
Jul 8, 2021
Beds
2
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1998 in TN
Enrollment address
1901 S Shady St
Mountain City, TN 37683-2021
Main/Primary Hospital Location
Hospital subgroups
Other

Hospital certification: CCN 440221

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
(CLOSED) JOHNSON COUNTY HEALTH CENTER
Certification status
Terminated Other: provider status change, Sep 13, 2001
Provider type (POS)
Hospital – Short-term
Participating since
Jun 18, 2001
Last certification
Jun 18, 2001
Beds
2
Ownership / control type
Other
Facility address
1901 South Shady Street
Mountain City, TN 37683

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

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: Hospital

Medicare Care Compare
Listed as
Johnson County Community HospitalCCN 441304 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0946736Johnson County Community Hospital1901 South Shady Street, Mountain City, TN 37683AccreditationNov 5, 2026

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Psychia41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

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 DirectorBoard Member 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
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 26

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 HomecareJohnson City, TN, CCN 447240 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jan 8, 2007
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 28

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

View all 28

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

Affiliated clinicians 56

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

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1497859789",
    "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": "423-727-1100",
            "fax_number": "423-727-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S SHADY ST",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376832021",
            "telephone_number": "423-727-1100",
            "fax_number": "423-727-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "TN",
            "license": "0000000038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001915",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4001915",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0441304",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4401304",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091618800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93633835A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "100020317",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004413041",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11500B",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2669036",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "4001915",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "A3768308",
            "state": null
        }
    ],
    "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": "Mountain States Health Alliance",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "1901 S Shady St",
            "city": "Mountain City",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376832021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Johnson County Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Johnson County Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain City, TN

Sources for this page

Verify at the official NPI Registry.