NPIMap

Organization Active NPI

Dickenson Community Hospital, Inc.

Doing business as Bhrhc Dickenson

  • Rural Health Clinic/Center
  • Clintwood, VA
National Provider Identifier
1952072407
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DICKENSON COMMUNITY HOSPITAL, INC.
Doing business as
Bhrhc Dickenson
Practice address
364 Hospital Dr
Clintwood, VA 24228-6786
Phone
(276) 926-0200
Fax
(276) 926-6675
NPI assigned
Sep 24, 2021
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
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

364 Hospital Dr
Clintwood, VA 24228-6786

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2080
Phone (276) 926-0200

Other names 1

  • BHRHC DICKENSON Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other DICKENSON COMMUNITY HOSPITAL, INC.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211105000508 VA Part A Provider - Rural Health Clinic 8921096561 Practice locations: Clintwood, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952072407. Details of each certification follow.

Rural health clinic certification: CCN 493463

Legal name
DICKENSON COMMUNITY HOSPITAL, INC.
Doing business as
BHRHC DICKENSON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 25, 2022
Last certification
Oct 25, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 30, 2003 in VA
Enrollment address
364 Hospital Dr
Clintwood, VA 24228-6786
Related CCNs
491303

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Dickenson Medical Associates a Department of Dickenson Community Hospi4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 8

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
Wellmont Health System Organization, Kingsport, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 28, 2021 100%
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

Owners & managing parties with NPI records 9

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

Facilities with the same owner 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1952072407",
    "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": "376012080",
            "telephone_number": "276-926-0200",
            "fax_number": "276-926-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 HOSPITAL DR",
            "city": "CLINTWOOD",
            "state": "VA",
            "postal_code": "242286786",
            "telephone_number": "276-926-0200",
            "fax_number": "276-926-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKENSON COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-24",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": "DICKENSON COMMUNITY HOSPITAL, INC.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "1.5, 1.6",
            "address_1": "364 Hospital Dr",
            "city": "Clintwood",
            "state": "VA",
            "country_code": "US",
            "postal_code": "242286786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BHRHC DICKENSON",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BHRHC DICKENSON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clintwood, VA

Sources for this page

Verify at the official NPI Registry.