NPIMap

Organization Active NPI

Community Action Committee of Pike County

Doing business as West Portsmouth Family Practice

  • Federally Qualified Health Center (FQHC)
  • West Portsmouth, OH
National Provider Identifier
1003908930
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Doing business as
West Portsmouth Family Practice
Practice address
23030 State Route 73
West Portsmouth, OH 45663-8861
Phone
(740) 858-1063
NPI assigned
Sep 28, 2006
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
Keith Eric Pitts
Title
Executive Director
Phone
(740) 289-2371

Specialties & licenses 1

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

Addresses

Primary practice location

23030 State Route 73
West Portsmouth, OH 45663-8861

Mailing address

941 Market St
Piketon, OH 45661-9757
Phone (740) 289-2371

Other identifiers 1

IdentifierTypeStateIssuer
2081349MedicaidOH

Other names 1

  • West Portsmouth Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101201000247 OH Part A Provider - Federally Qualified Health Center (FQHC) 3173432762 Practice locations: Portsmouth, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003908930. Details of each certification follow.

Federally qualified health center certification: CCN 361874

Legal name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1998
Last certification
Jul 1, 1998
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1965 in OH
Enrollment address
23030 State Route 73
Portsmouth, OH 45663-8861

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Community Action Commit32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

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
Sandi King Individual Corporate Director Jan 19, 2023
Pamela Johnson Individual Corporate DirectorGoverning Board Member Mar 22, 2018
Phyllis Snyder Individual Corporate DirectorGoverning Board Member Mar 20, 2008
Lindsay Schrader Individual Corporate DirectorGoverning Board Member Apr 21, 2018
Rick Patrick Individual Corporate DirectorGoverning Board Member Jan 4, 2010
Blaine Beekman Individual Corporate Director Jan 15, 2015
Keith Pitts Individual Corporate OfficerExecutive Director Apr 23, 2016
W-2 Managing EmployeeExecutive Director Apr 23, 2016
Lori Salisbury Individual W-2 Managing EmployeeInsurance Credentialing Specialist Sep 15, 2008
Jerry Miller Individual Corporate DirectorBoard Member Mar 18, 2021
Justin Brewster Individual Corporate DirectorGoverning Board Member Jun 22, 2017
Chandler Grooms Individual Corporate Director Apr 20, 2023
Jamie Adams Individual Corporate Director Sep 21, 2023
Anthony Moraleja Individual Corporate DirectorBoard Member Apr 15, 2021
Rob Junk Individual Corporate DirectorGoverning Board Member Mar 20, 2014
Paul Price Individual Corporate DirectorGoverning Board Member Jan 19, 2017
Chase Brown Individual Corporate DirectorBoard Member Jul 15, 2021
David Bevens Individual Corporate Director May 9, 2022

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Manchester Family Health CenterManchester, OH, CCN 361050 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 19, 2014
Valley View 23 NorthWaverly, OH, CCN 721918 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 30, 2021

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1003908930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 MARKET ST",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "456619757",
            "telephone_number": "740-289-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23030 STATE ROUTE 73",
            "city": "WEST PORTSMOUTH",
            "state": "OH",
            "postal_code": "456638861",
            "telephone_number": "740-858-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ACTION COMMITTEE OF PIKE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "PITTS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "740-289-2371"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2081349",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Portsmouth Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Portsmouth Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Portsmouth, OH

Sources for this page

Verify at the official NPI Registry.