Shenandoah Valley Medical System, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Winchester, VA
NPI 1023217452 · NPPES record last updated Oct 23, 2019
Key facts
- NPI
- 1023217452
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
- Practice address
- 1330 Amherst St
Winchester, VA 22601-3054 - Phone
- (304) 263-4999
- Fax
- (304) 263-0984
- NPI assigned
- Jul 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Michael Hassing
- Title
- Ceo
- Phone
- (304) 263-4999
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 10
Subparts reporting this organization as parent 1
Related certifications (CCN) 1
Practitioners 174
-
Khalid Albedrani, M.D.
-
Victoria Lynn Harmon, LPC
-
Michelle Lee Kling, APRN
-
Yarisvett Rosa Rivera, FNP-C
-
Connie Van Baah, CNM
-
Douglas Van Sickle, ARNP, FNP-BC
-
Renee Vansickle, ARNP
-
Hanan Kallash, FNP
-
Emmaleigh Ana Mondell, PA-C
-
Billirt Zeeh Ambe, PMHNP-BC
-
Brittany Ann Beard, FNP-C
-
Jana Denise Brannon, WHNP-BC
-
Michelle Marie Cooper, CRNP
-
Robert Cuthbert, LPC, CAC
-
Gnima Diaw, PMHNP
-
Kristy Divelbliss, PA-C
-
Heather Anne Eckenrode, MSN, RN, FNP-BC
-
Melisa Figueroa, LICSW
-
Victoria Ann Flynn, LICSW
-
Melinda Ann Headley, FNP-BC
-
Shafwan Khan, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D1031651 | Winchester Family Health Center | Provider-performed microscopy | Oct 5, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, WV
Federally qualified health center certification: CCN 491840
- Legal name
- SHENANDOAH VALLEY MEDICAL SYSTEM,INC.
- Doing business as
- WINCHESTER FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 30, 1998
- Last certification
- Jun 30, 1998
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 7, 1976 in WV
- Enrollment address
- 1330 Amherst St
Winchester, VA 22601-3054 - Related CCNs
- 511844
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Annley Nikki Bigiarelli |
Corporate Director |
Dec 6, 2022 | |
| John Charlton |
Corporate Officer |
Apr 3, 2023 | |
| Harold Shrewsberry |
Corporate Officer |
Apr 3, 2023 | |
| Frank S Coe |
Corporate Officer |
Jan 4, 2021 | |
| Todd M Lockcuff |
Corporate Officer |
Sep 1, 2025 | 100% |
| W-2 Managing Employee |
Sep 1, 2025 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050613000473 | VA | Part B Supplier - Clinic/Group Practice | 9739093097 |
Receives reassigned benefits from 13 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Winchester, VA |
| O20090312000099 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 9739093097 |
1 other NPI on this enrollment Practice locations: Winchester, VA |
National Provider Directory
Locations
1330 Amherst St
Ste C
Winchester, VA 22601
Phone (540) 662-6400
250 East Rd
Martinsburg, WV 25404
2000 Tavern Rd
Martinsburg, WV 25401
Phone 30426349991063
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1330 Amherst St
Winchester, VA 22601-3054
Mailing address
PO Box 1146
Martinsburg, WV 25402-1146
Phone (304) 263-4999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007604475 | Medicaid | VA |
Other names
- Winchester Family Health Center
Other providers in Winchester, VA
- Shenandoah University
- Shenandoah Valley Community Residences, Inc.
- Shenandoah Valley Family Practicellc
- Shenandoah Valley Implant Institute
- Shenandoah Valley Implant Institute of Winchester
- Shenandoah Valley Medical System, Inc.
- Shenandoah Valley Orthodontic Specialists, PC
- Shenandoah Valley Pathology Laboratories Inc
- Colleen Shendow
- Amy Joy Shepley
All providers in Winchester, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2019. 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.