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Northern Hospital District of Surry County

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Mount Airy, NC

NPI 1811995186 · NPPES record last updated Feb 3, 2025

Key facts

NPI
1811995186
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
H0184 (NC)
Legal business name
NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Practice address
830 Rockford St
Mount Airy, NC 27030-5322
Phone
(336) 719-7000
Fax
(336) 719-7199
NPI assigned
Jul 12, 2005
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 12

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

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

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

Facilities with the same owner 18

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

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 41

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Hospital certification: CCN 34U003

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

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

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 Care
Dobson, NC · CCN 341546		 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Mountain Valley Hospice & Palliative Care
Galax, VA · CCN 491580		 Hospice 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2005
Northern Obstetrics & Gynecology
Mount Airy, NC · CCN 343480		 Rural health clinic Operational/Managerial Control (100%) Jan 1, 1966
Northern Pediatrics
Mount Airy, NC · CCN 343481		 Rural health clinic Operational/Managerial Control (100%) Jan 1, 1966

Medicare enrollment records

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

National Provider Directory

Tax ID family
Northern Hosp of Surry Co (13 organizations share this tax ID)

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
0087JOtherNCBCBS/STATE/CENTRL STS SWI
3450003MedicaidNC
3460003MedicaidNC

Other names

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

Other providers in Mount Airy, NC

All providers in Mount Airy, NC · Medicare Defined Swing Bed Hospital Unit in North Carolina

Sources for this page

Verify at the official NPI Registry.