Bluestone Health Association, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Princeton, WV
NPI 1003453317 · NPPES record last updated Feb 24, 2021
Key facts
- NPI
- 1003453317
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BLUESTONE HEALTH ASSOCIATION, INC.
- Practice address
- 106 Thorn St
Princeton, WV 24740-3560 - Phone
- (681) 282-5609
- Fax
- (304) 936-6157
- NPI assigned
- Dec 5, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- BLUESTONE HEALTH ASSOCIATION, INC.
Authorized official
- Name
- Linda Hutchens
- Title
- Ceo
- Phone
- (304) 431-3410
Other NPIs with the same Medicare PAC ID 6
Practitioners 43
-
Susan Fawn Blevins, FNP
-
Randy M Brodnik, DO FACOG
-
Leigh Brooks, APRN FNP-C
-
Heather Marie Cook, PA-C
-
Jessica Ann Deel, NP-C
-
Bretina Hightower, BS, MSW, LGSW
-
Brandi Huffman, PA-C
-
Sabrina Kay Huffman, MSN, FNP
-
Brooke Alexandria Kirk, FNP-BC
-
Amy Lane, FNP-C
-
Miranda Lester, RN
-
Melissa D Lucado, FNP-C
-
Leah Renee Mooney, FNP-C
-
Nicholas Samuel Muscari, D.O.
-
Samantha Dawn Nunley, FNP-C
-
Shelly Denise Pack, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511195
- Legal name
- BLUESTONE HEALTH ASSOCIATION, INC.
- Doing business as
- BLUESTONE PRIMARY CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 29, 2020
- Last certification
- Oct 29, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 19, 1976 in WV
- Enrollment address
- 106 Thorn St
Princeton, WV 24740-3560
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Norman Fletcher |
Other |
Jan 1, 1995 | |
| Norma Clark |
Other |
Jan 1, 2010 | |
| Pete Stamolis |
Other |
Jan 1, 2001 | |
| Linda Hutchens |
Corporate Director |
Sep 1, 1993 | |
| W-2 Managing Employee |
Sep 1, 1993 | ||
| Marsha Howell |
Other |
Jan 1, 1986 | |
| Mary Joann Dixon |
Corporate Officer |
Nov 30, 2020 | |
| Melanie Jessee |
Other |
Oct 22, 2012 | |
| Susanne Pulse |
Corporate Officer |
Nov 30, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201029003115 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 3577505221 | Practice locations: Princeton, WV |
| O20210226000722 | WV | Part B Supplier - Clinic/Group Practice | 3577505221 |
Receives reassigned benefits from 40 practitioners Practice locations: Princeton, WV |
National Provider Directory
- Part of
- Bluestone Health Center Pharmacy
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71392
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
106 Thorn St
Princeton, WV 24740-3560
Mailing address
3997 Beckley Rd
Princeton, WV 24740-7660
Phone (304) 431-5499
Other names
- Bluestone Primary Care
Other providers in Princeton, WV
- Ontashia Blizzard
- Blue Ridge Internal Medicine Inc.
- Blue Ridge Internal Medicine Inc.
- Bluefield Gastroenterology PLLC
- Bluefield Mental Health Center, PC
- Bluestone Health Association, Inc.
- Bluestone Health Association, Inc.
- Bluestone Health Association, Inc.
- Bluestone Health Association, Inc.
- Bluestone Health Center Pharmacy
All providers in Princeton, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.