NPIMap

Organization Active NPI

Hospice of Surry County, Inc

Doing business as Mountain Valley

  • Community Based Hospice Care Agency
  • Dobson, NC
National Provider Identifier
1851355424
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HOS1001 Issued in NC
Legal business name
HOSPICE OF SURRY COUNTY, INC
Doing business as
Mountain Valley
Mountain Valley Hospice and Palliative Care
Practice address
105 N Crutchfield St Unit 2
Dobson, NC 27017-8804
Phone
(336) 789-2922
Fax
(336) 789-0856
NPI assigned
Apr 12, 2006
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Mrs. Tracey Smith Dobson, RN, BSN
Title
Interim Ceo
Phone
(336) 789-2922

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HOS0404 NC
Community Based Hospice Care Agency 251G00000X HOS1303 NC
Community Based Hospice Care Agency 251G00000X HC1498 NC
Community Based Hospice Care Agency 251G00000X HOS1001 NC Primary

Addresses

Primary practice location

105 N Crutchfield St Unit 2
Dobson, NC 27017-8804

Mailing address

PO Box 325
Dobson, NC 27017-0325
Phone (336) 789-2922

Other practice location 1

688 N Bridge St
Elkin, NC 28621-3005
Phone (336) 526-2650

Other practice location 2

129 Veterans Dr
Pilot Mountain, NC 27041-9609
Phone (336) 368-1260

Other practice location 3

243 N Lee Ave
Yadkinville, NC 27055-5431
Phone (336) 677-1692

Other practice location 4

945 Zephyr Rd
Dobson, NC 27017-7708
Phone (336) 356-5000

Other names 2

  • Mountain Valley Doing business as
  • Mountain Valley Hospice and Palliative Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050701000267 NC Part A Provider - Hospice 2961448741 Practice locations: Yadkinville, NC; Pilot Mountain, NC; Dobson, NC; Elkin, NC
O20080929000387 NC Part B Supplier - Clinic/Group Practice 2961448741 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: King, NC; Yadkinville, NC; Winston Salem, NC; Pilot Mountain, NC; Mount Airy, NC; Dobson, NC; Elkin, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851355424. Details of each certification follow.

Hospice certification: CCN 341546

Legal name
HOSPICE OF SURRY COUNTY INC
Doing business as
MOUNTAIN VALLEY HOSPICE & PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 5, 1990
Last certification
Jun 27, 2007
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Nov 8, 1982 in NC
Enrollment address
105 N Crutchfield St
Unit 2
Dobson, NC 27017-8804

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Mountain Valley Hospice & Palliative CareCCN 341546 · All quality measures
Ownership
Non-Profit
Certified
Jan 5, 1990
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

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

Locations

688 N Bridge St
Elkin, NC 28621
Phone (336) 526-2565

401 Technology Ln
Ste 200
Mount Airy, NC 27030
Phone (336) 789-2922

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Northern Hospital of Surry County Organization, Mount Airy, NC 5% Or Greater Direct Ownership Interest Oct 1, 2005 50%
Barry S Dowell Individual Corporate OfficerCfo Oct 23, 2017
W-2 Managing Employee Oct 23, 2017
Hugh Chatham Memorial Hospital Inc Organization, Elkin, NC Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2005 50%
Glenn Golaszewski Individual Contracted Managing EmployeeMD; Sep 2, 2008
Tracey Smith Dobson Individual Corporate OfficerInterim Ceo May 20, 2020
Corporate DirectorInterim Ceo May 20, 2020
W-2 Managing EmployeeAd; May 20, 2020
Tara Dowell Individual W-2 Managing Employee Sep 26, 2007

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mountain ValleyFort Mill, SC, CCN 421654 Hospice 5% Or Greater Indirect Ownership Interest (8%) Dec 11, 2024

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1851355424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 325",
            "city": "DOBSON",
            "state": "NC",
            "postal_code": "270170325",
            "telephone_number": "336-789-2922",
            "fax_number": "336-789-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N CRUTCHFIELD ST UNIT 2",
            "city": "DOBSON",
            "state": "NC",
            "postal_code": "270178804",
            "telephone_number": "336-789-2922",
            "fax_number": "336-789-0856"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "688 N Bridge St",
            "address_purpose": "LOCATION",
            "city": "Elkin",
            "state": "NC",
            "postal_code": "286213005",
            "country_code": "US",
            "telephone_number": "336-526-2650",
            "fax_number": "336-526-2370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "129 Veterans Dr",
            "address_purpose": "LOCATION",
            "city": "Pilot Mountain",
            "state": "NC",
            "postal_code": "270419609",
            "country_code": "US",
            "telephone_number": "336-368-1260",
            "fax_number": "336-368-1263",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "243 N Lee Ave",
            "address_purpose": "LOCATION",
            "city": "Yadkinville",
            "state": "NC",
            "postal_code": "270555431",
            "country_code": "US",
            "telephone_number": "336-677-1692",
            "fax_number": "336-677-1697",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "945 Zephyr Rd",
            "address_purpose": "LOCATION",
            "city": "Dobson",
            "state": "NC",
            "postal_code": "270177708",
            "country_code": "US",
            "telephone_number": "336-356-5000",
            "fax_number": "336-356-5001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOSPICE OF SURRY COUNTY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "DOBSON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "SMITH",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "336-789-2922",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HOS0404",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HOS1303",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HC1498",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HOS1001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Valley",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Valley Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Valley Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dobson, NC

Sources for this page

Verify at the official NPI Registry.