NPIMap

Organization Active NPI

Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
National Provider Identifier
1962915652
Registry record updated Mar 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Practice address
400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone
(423) 431-6111
Fax
(423) 431-3549
NPI assigned
Nov 16, 2017
Organization subpart
Yes
Parent organization
MOUNTAIN STATES HEALTH ALLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2018

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

Authorized official

Name
Mary Lynn Krutak
Title
Evp/Cfo
Phone
(423) 302-3423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

400 N State of Franklin Rd
Johnson City, TN 37604-6035

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 431-6111

Other names 1

  • Johnson City Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050426001136 TN Part A Provider - Hospital 6002726718 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Hospital certification: CCN 440063

Legal name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
JOHNSON CITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 28, 2015
Beds
585
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1945 in TN
Enrollment address
400 N State of Franklin Rd
Johnson City, TN 37604-6035
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Children’s, Psychiatric, Rehabilitation, Short-term, Psychiatric unit

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Johnson City Medical CenterCCN 440063
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Mountain States Health Alliance

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 DirectorEvp/Cfo 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, Chain home office 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

Practitioners & affiliated clinicians

Affiliated clinicians 1,089

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

View all 1,089

NPI Registry JSON

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

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520985600000",
    "number": "1962915652",
    "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": "423-431-6111",
            "fax_number": "423-431-3549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046035",
            "telephone_number": "423-431-6111",
            "fax_number": "423-431-3549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "enumeration_date": "2017-11-16",
        "last_updated": "2018-03-14",
        "status": "A",
        "authorized_official_last_name": "KRUTAK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "423-302-3423"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson City Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Johnson City Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.