NPIMap

Organization Active NPI

Community Health Association

Doing business as Jackson General Care Clinic

  • Family Medicine Physician
  • Ripley, WV
National Provider Identifier
1023599594
Registry record updated Mar 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY HEALTH ASSOCIATION
Doing business as
Jackson General Care Clinic
Practice address
509 Church St S
Ripley, WV 25271-1615
Phone
(304) 372-2731
NPI assigned
Aug 23, 2018
Last updated
Mar 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2022

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

Authorized official

Name
Brenda Gail Greene
Title
Medcial Staff Coordinator
Phone
(304) 373-1507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

509 Church St S
Ripley, WV 25271-1615

Mailing address

122 Pinnell St
Ripley, WV 25271-9101
Phone (304) 372-2731

Other names 1

  • Jackson General Care Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000784 WV Part B Supplier - Clinic/Group Practice 1759291313 Receives reassigned benefits from 135 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ripley, WV; Ravenswood, WV

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1023599594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 PINNELL ST",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252719101",
            "telephone_number": "304-372-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 CHURCH ST S",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252711615",
            "telephone_number": "304-372-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-23",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "MEDCIAL STAFF COORDINATOR",
        "authorized_official_telephone_number": "304-373-1507"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jackson General Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ripley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.