Mountain States Health Alliance
Organization Active NPI General Acute Care Hospital · Kingsport, TN
NPI 1992813240 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1992813240
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 0000000134 (TN)
- Legal business name
- MOUNTAIN STATES HEALTH ALLIANCE
- Practice address
- 2000 Brookside Dr
Kingsport, TN 37660-4627 - Phone
- (423) 857-7000
- Fax
- (423) 857-7078
- NPI assigned
- Aug 28, 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 with the same Medicare PAC ID 20
Corporate family (same tax ID) 40
Facilities with the same owner 40
Practitioners 41
-
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
-
Delmon E Ashcraft Jr., M.D.
-
Mark Brummel, D.O.
Affiliated clinicians 345
-
Christopher Adams, PA-C
-
Nimesh Adhikari, MD
-
Jeremy S Adkins, N.P.
-
Kayla O Almanzor, NP
-
Kierra Anderson, FNP-C
-
David J Arrowood, CRNA
-
Brittany Arwood, CRNA
-
Emily Atwood, AUD
-
Mark Aziz, MD
-
Tonya D Baker, FNP
-
Mandeep S Bakshi, MD
-
Thomas Alan Barklow, M.D.
-
Lauren Alexander Barrett, FNP-BC
-
Chad Bates, M.D.
-
James P Beckner, MD
-
Ashley H Begley, NP-C
-
Holly Amber Berndt, M.D.
Medicare Care Compare: Hospital
- Listed as
- Indian Path Community Hospital
- 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 440176
- Legal name
- MOUNTAIN STATES HEALTH ALLIANCE
- Doing business as
- INDIAN PATH COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Mar 1, 1974
- Last certification
- Jul 1, 2001
- Beds
- 239
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1945 in TN
- Enrollment address
- 2000 Brookside Dr
Kingsport, TN 37660-4627 - Hospital subgroups
- General, Acute care, Psychiatric, 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 |
|---|---|---|---|---|
| O20050329000505 | TN | Part a Provider - Hospital | 6002726718 | Practice locations: Kingsport, TN |
National Provider Directory
- Tax ID family
- Mountain States Health Alliance
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 0000000134 | TN | Yes |
Addresses
Primary practice location
2000 Brookside Dr
Kingsport, TN 37660-4627
Mailing address
311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 857-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000363855X | Medicaid | GA | |
| 01600113 | Medicaid | KY | |
| 1000807 | Other | BLUE CROSS | |
| 17505000 | Other | MAGELLAN | |
| 004401760 | Medicaid | VA | |
| 00672239 | Medicaid | MS | |
| 0440176 | Medicaid | TN | |
| 3457347 | Other | CIGNA | |
| 0938025 | Medicaid | OH | |
| A3766020 | Other | JOHN DEERE | |
| 091618800 | Medicaid | FL | |
| 4400176 | Medicaid | NC | |
| 4699873 | Medicaid | MI | |
| 000127730 | Medicaid | SC | |
| 030138700 | Other | BLACK LUNG | |
| 226529 | Other | ANTHEM | |
| 4699882 | Medicaid | MI |
Other names
- Indian Path Community Hospital
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 Kingsport, 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 Out-Patient Behavioral Health
- Mountain View Medical Center, LLC
- Jenny Mull
- Angel Kaye Mullins
- Austin Hunter Mullins
All providers in Kingsport, 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.