NPIMap

Organization Active NPI

Northern Hospital District of Surry County

Doing business as Northern Regional Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Mount Airy, NC
National Provider Identifier
1811995186
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H0184 Issued in NC
Legal business name
NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Doing business as
Northern Regional Hospital
Practice address
830 Rockford St
Mount Airy, NC 27030-5322
Phone
(336) 719-7000
Fax
(336) 719-7199
NPI assigned
Jul 12, 2005
Last updated
Feb 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Authorized official

Name
Robin Allen
Title
Director Central Billing
Phone
(336) 719-7129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H0184 NC Primary

Addresses

Primary practice location

830 Rockford St
Mount Airy, NC 27030-5322

Mailing address

PO Box 1101
Mount Airy, NC 27030-1101
Phone (336) 719-7000

Other names 2

  • Northern Regional Hospital Doing business as
  • Northern Hospital of Surry County Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100702000416 NC Part A Provider - Hospital 0244281749 Practice locations: Mount Airy, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811995186. Details of each certification follow.

Hospital certification: CCN 34U003

Legal name
NORTHERN HOSPITAL OF SURRY COUNTY
Doing business as
NORTHERN REGIONAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
830 Rockford St
Mount Airy, NC 27030-5322
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Roland L Boyd MD13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paul Patterson Individual Corporate DirectorBoard Member Oct 1, 2013
David Shockley Individual Corporate DirectorBoard Member Oct 1, 2013
Ovation Health Organization, Brentwood, TN LLC Operational/Managerial Control Sep 27, 1994
Tommy Riggs Individual Corporate DirectorBoard Member Mar 4, 1999
Derek White Individual Operational/Managerial ControlDirector of Accounting Oct 18, 1999
William Woltz Individual Corporate DirectorBoard Member - Vice Chairman & T Dec 27, 1989
Phillip Cook Individual Corporate DirectorBoard Member Oct 1, 1999
Teresa Lewis Individual Corporate DirectorBoard Member Dec 1, 2014
Ruben Golding Individual Corporate DirectorBoard Member Oct 1, 2010
Druery R Devore Individual Corporate DirectorBoard Member Jan 1, 2017
Monty Venable Individual Corporate DirectorBoard Member Oct 1, 2003
Andrea Hickling Individual Corporate OfficerCheif Financial Officer Aug 1, 2013
David Gillespie Individual Corporate DirectorBoard Member Oct 1, 1999
Phillip Snow Individual Corporate DirectorBoard Member Oct 1, 2003

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Mountain Valley Hospice & Palliative CareDobson, NC, CCN 341546 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Mountain Valley Hospice & Palliative CareGalax, VA, CCN 491580 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Northern Obstetrics & GynecologyMount Airy, NC, CCN 343480 Rural health clinic Operational/Managerial Control (100%) Jan 1, 1966
Northern PediatricsMount Airy, NC, CCN 343481 Rural health clinic Operational/Managerial Control (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738540800000",
    "number": "1811995186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1101",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270301101",
            "telephone_number": "336-719-7000",
            "fax_number": "336-719-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 ROCKFORD ST",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270305322",
            "telephone_number": "336-719-7000",
            "fax_number": "336-719-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "DIRECTOR CENTRAL BILLING",
        "authorized_official_telephone_number": "336-719-7129"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NC",
            "license": "H0184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Hospital of Surry County",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Airy, NC

Sources for this page

Verify at the official NPI Registry.