Mountain States Health Alliance
Organization Active NPI General Acute Care Hospital · Johnson City, TN
NPI 1972606465 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1972606465
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 0000000121 (TN)
- 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) 431-3986
- NPI assigned
- Sep 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Shane Edwin Hilton
- Title
- Evp/Cfo
- Phone
- (423) 302-3467
Owned or controlled facilities with NPI records 28
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 20
Corporate family (same tax ID) 40
Related certifications (CCN) 1
Facilities with the same owner 40
Practitioners 79
-
Jamie E Carnell, NP
-
Dennis Charles Desimone, D.O.
-
Holly Ann Fisk, FNP-C
-
Christopher R. Gabler, P.A.-C.
-
Johanna Galyen, FNP-C
-
Danielle S Giles, NP
-
Deborah J Hassebrock, FNP
-
Ruth D Johnson, MSN
-
Jamie G McNutt, FNP
-
Suzan Page, N.P.
-
Sakshi Singal, M.D.
-
Lindsey Debord Yoggerst, FNP-BC
-
Bradley Wayne Beeler, M.D.
-
Candice M Bolling, P.A.-C
-
Emily Brooke Crabtree, FNP-C
-
Steven Lester, PMHNP
-
Matthew Rendo, M.D.
-
Laura Marie Walts, M.A., LPC
-
Benedict E Aimua, MD
-
Leon Charles Bass, M.D.
Affiliated clinicians 1,089
-
Tiffany Danielle Abel, FNP-BC
-
Bruce A Abkes, MD
-
Abigail L Abram, FNP
-
Christopher Adams, PA-C
-
Ezra Allen Adams, DO
-
Stephanie Ann Adams, D.O.
-
Nimesh Adhikari, MD
-
Brent Aebi, M.D.
-
Manal Ahmad, M.D.
-
Benedict E Aimua, MD
-
Faith A Aimua, MD
-
Megan Teresa Akins, D.O.
-
Rania A Al Asmar, MD
-
Ahmad Albalbissi, M.D.
-
Melony April Almany, FNP
-
David Q Andrews, CRNA
-
Sarah Arif, M.D.
-
Eric Dakota Artrip, FNP
Medicare Care Compare: Hospital
- Listed as
- Johnson City Medical Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
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
- Corporation · Non-profit
- Incorporated
- Apr 12, 1945 in TN
- Enrollment address
- 400 N State of Franklin Rd
Johnson City, TN 37604-6035 - Hospital subgroups
- General, Acute care, Children’s, Psychiatric, Rehabilitation, Short-term, Psychiatric unit
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Shane Hilton |
Corporate Officer |
Apr 4, 2024 | |
| Corporate Director |
Apr 4, 2024 | ||
| Gregory Wilgocki |
Corporate Director |
Feb 1, 2018 | |
| W-2 Managing Employee |
Feb 1, 2018 | ||
| Ballad Health |
5% Or Greater Indirect Ownership Interest | Feb 1, 2018 | 100% |
| Marvin Eichorn |
Corporate Officer |
Feb 1, 2018 | |
| Corporate Director |
Feb 1, 2018 | ||
| Buford Deaton |
Corporate Officer |
Feb 1, 2018 | |
| Corporate Director |
Feb 1, 2018 | ||
| Alan Levine |
Corporate Officer |
Feb 1, 2018 | |
| Corporate Director |
Feb 1, 2018 | ||
| Julie Bennett |
Corporate Officer |
Feb 1, 2023 | |
| Corporate Director |
Feb 1, 2023 |
All facility ownership & control disclosures 26
| Facility | Type | Role | Since |
|---|---|---|---|
| Smyth County Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Rehabilitation Hospital of Kingsport, a Joint Venture of Ballad Health |
Hospital | 5% Or Greater Indirect Ownership Interest (11%) | Jan 1, 2021 |
| Woodridge Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2005 |
| Johnston Memorial Hospital Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Smyth County Swing Bed Unit |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Russell County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2008 |
| Russell County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2008 |
| Sycamore Shoals Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 1998 |
| Rehabilitation Hospital of Bristol, a Joint Venture of Ballad Health a |
Hospital | 5% Or Greater Indirect Ownership Interest (25%) | Nov 1, 2021 |
| Southwest Virginia Inpatient Rehab |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2021 |
| Quillen Rehabilitation Hospital, a JV of Ballad Health and Encompass |
Hospital | 5% Or Greater Indirect Ownership Interest (49.9%) | Sep 30, 2014 |
| Lee County Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2021 |
| Princeton Transitional Care and Assisted Living |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest (100%) | Dec 3, 2018 |
| Wexford House |
Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (5%) |
May 1, 2025 May 1, 2025 |
| Laughlin Healthcare Center |
Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (5%) |
May 1, 2025 May 1, 2025 |
| Francis Marion Manor Health & Rehabilitation |
Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (5%) |
May 1, 2025 May 1, 2025 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jan 8, 2007 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| Ballad Health Homecare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 2020 |
| Ballad Health Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Ballad Health Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2018 |
| Bhrhc Mtncity |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Sep 13, 2001 |
| Bhrhc Glade |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Nov 10, 2021 |
| Bhrhc Stpaul |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2008 |
| Bhrhc Lebanon |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 7, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050426001136 | TN | Part a Provider - Hospital | 6002726718 | 2 other NPIs on this enrollment |
National Provider Directory
- Tax ID family
- Mountain States Health Alliance
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | 0000000121 | TN | |
| General Acute Care Hospital | 282N00000X | 0000000121 | TN | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4699882 | Medicaid | MI | |
| 000262138X | Medicaid | GA | |
| 01675483 | Medicaid | NY | |
| 0440063 | Medicaid | TN | |
| 42332 | Medicaid | SC | |
| 01620418 | Medicaid | KY | |
| 070026 | Other | CIGNA | |
| 091618800 | Medicaid | FL | |
| 1749478 | Medicaid | LA | |
| JOH0063N | Medicaid | AL | |
| 030283600 | Other | BLACK LUNG | |
| 05431336 | Medicaid | MS | |
| 0579913 | Medicaid | OH | |
| 9802156000 | Medicaid | WV | |
| 4400063 | Medicaid | NC | |
| 463496 | Medicaid | SC | |
| 4688190 | Medicaid | MI | |
| A3760501 | Other | JOHN DEERE |
Other names
- Johnson City Medical Center
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | Mountain States Health Alliance |
Other providers in Johnson City, TN
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance
- Mountain States Health Alliance Indian Path Medical Center
- Mountain States Health Alliance Indian Path Medical Center
- Mountain States Health Alliance Sycamore Shoals Hospital
- Leslie Ann Moxley
- Benjamin Thomas Moyer
All providers in Johnson City, TN · General Acute Care Hospital in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.