NPIMap

Organization Active NPI

New River Health Association, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fayetteville, WV
National Provider Identifier
1003301912
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEW RIVER HEALTH ASSOCIATION, INC.
Practice address
515 W Maple Ave
Fayetteville, WV 25840-1419
Phone
(304) 469-2905
Fax
(304) 469-2981
NPI assigned
Jun 25, 2018
Organization subpart
Yes
Parent organization
NEW RIVER HEALTH ASSOCIATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Marissa Johnson
Title
Credentialing Officer
Phone
(304) 469-2905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X WV Primary

Addresses

Primary practice location

515 W Maple Ave
Fayetteville, WV 25840-1419

Mailing address

497 Mall Rd
Oak Hill, WV 25901-6216
Phone (304) 469-2905

Other names 1

  • Fayetteville PK-8 School Based Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200302002231 WV Part A Provider - Federally Qualified Health Center (FQHC) 2365348596 Practice locations: Fayetteville, WV
O20200602000032 WV Part B Supplier - Clinic/Group Practice 2365348596 Receives reassigned benefits from 5 practitioners
Practice locations: Fayetteville, WV

Federally qualified health center certification: CCN 511179

Legal name
NEW RIVER HEALTH ASSOCIATION INC
Doing business as
FAYETTEVILLE PK-8 SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 2, 2020
Last certification
Mar 2, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1976 in WV
Enrollment address
515 W Maple Ave
Fayetteville, WV 25840-1419

Other NPIs with the same Medicare PAC ID 21

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

View all 21

National Provider Directory

National Provider Directory
Part of
New River Health Associ

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Angela M Barker Individual Corporate Officer Feb 1, 2014
Sharon Bradley Individual Corporate DirectorBoard Member May 1, 2015
Nathan Hollister Individual Corporate OfficerBoard Member Jan 1, 2020
Marissa Johnson Individual W-2 Managing Employee Jan 7, 2019
New River Health Association Inc Organization, Scarbro, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 27, 1976 100%
Robert Simmons Individual Corporate DirectorBoard Member Jul 1, 2006
Paul Lively Individual Corporate OfficerBoard Member Jul 1, 1978
Rose Michaels Individual Corporate OfficerBoard Member Nov 1, 2014
Gabriel Pena Individual Corporate Officer Nov 11, 2013
Michele Sarrett Individual Corporate OfficerCfo Feb 25, 2025
John R Schultz Individual Corporate Officer Jul 1, 2013
Evelyn Hizer Individual Corporate OfficerBoard Member Jul 1, 1995
Mark V Sundstrom Individual Corporate Officer Jun 30, 2023
Steve Pawlus Individual Corporate OfficerBoard Member Aug 27, 2020
Daniel B Doyle Individual Corporate Officer Mar 1, 2025
Angela Sundstrom Individual Corporate OfficerBoard Member Feb 1, 2016
Gary Hairston Individual Corporate OfficerBoard Member Sep 1, 2012

Owners & managing parties with NPI records 23

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

View all 23

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
New River Health - SophiaSophia, WV, CCN 511956 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Intermediate School Based Health CenterOak Hill, WV, CCN 511963 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
Oak Hill High School Based Health CenterOak Hill, WV, CCN 511962 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Nicholas County School Based Health CenterSummersville, WV, CCN 511965 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Coal City Elementary School Based Health CenterCoal City, WV, CCN 511969 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Independence School Based Health CenterCoal City, WV, CCN 511970 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Health - SummersvilleSummersville, WV, CCN 511124 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 1, 2017
Independence Middle School Based Health CenterCoal City, WV, CCN 511161 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 26, 2018
Jun 26, 2018
New River Health - SmithersSmithers, WV, CCN 511189 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - Oak HillOak Hill, WV, CCN 581809 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976

Owned or controlled facilities with NPI records 11

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1003301912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 MALL RD",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259016216",
            "telephone_number": "304-469-2905",
            "fax_number": "304-465-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 W MAPLE AVE",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401419",
            "telephone_number": "304-469-2905",
            "fax_number": "304-469-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "enumeration_date": "2018-06-25",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "304-469-2905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayetteville PK-8 School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, WV

Sources for this page

Verify at the official NPI Registry.