NPIMap

Organization Active NPI

Bluestone Health Association, Inc.

Doing business as Prudich Medical Center

  • Federally Qualified Health Center (FQHC)
  • Montcalm, WV
National Provider Identifier
1043387327
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BLUESTONE HEALTH ASSOCIATION, INC.
Doing business as
Prudich Medical Center
Practice address
5451 Simmons River Road
Montcalm, WV 24737
Phone
(304) 589-3251
Fax
(304) 589-5363
NPI assigned
Nov 29, 2006
Last updated
Oct 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Authorized official

Name
Mrs. Brittani Hutchens
Title
Ceo
Phone
(304) 320-2835

Specialties & licenses 1

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

Addresses

Primary practice location

5451 Simmons River Road
Montcalm, WV 24737

Mailing address

5451 Simmons River Rd.
Montcalm, WV 24737
Phone (304) 589-3251

Other names 1

  • Prudich Medical 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
O20050831000052 WV Part A Provider - Federally Qualified Health Center (FQHC) 3577505221 Practice locations: Montcalm, WV
O20051115000502 WV Part B Supplier - Public Health/Welfare Agency 3577505221 Receives reassigned benefits from 40 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Montcalm, WV; Princeton, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043387327. Details of each certification follow.

Federally qualified health center certification: CCN 511860

Legal name
BLUESTONE HEALTH ASSOCIATION, INC.
Doing business as
PRUDICH MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 1997
Last certification
Apr 16, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 26, 1976 in WV
Enrollment address
5451 Simmons River Rd
Montcalm, WV 24737-0736

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

3997 Beckley Rd
Princeton, WV 24740
Phone (304) 431-5499

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Norman Fletcher Individual Corporate OfficerBoard Member Jan 1, 1995
Norma Clark Individual Corporate OfficerBoard Member Jan 1, 2010
Pete Stamolis Individual Corporate OfficerBoard Member Jan 1, 2001
Linda Hutchens Individual Corporate DirectorChief Executive Officer Sep 1, 1993
W-2 Managing EmployeeChief Executive Officer Sep 1, 1993
Marsha Howell Individual Corporate OfficerBoard Member Jan 1, 1986
Mary Joann Dixon Individual Corporate OfficerBoard Member Nov 30, 2020
Melanie Jessee Individual Corporate OfficerBoard Member Oct 22, 2012
Susanne Pulse Individual Corporate OfficerBoard Member Nov 30, 2020

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791244800000",
    "number": "1043387327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5451 SIMMONS RIVER RD.",
            "city": "MONTCALM",
            "state": "WV",
            "postal_code": "24737",
            "telephone_number": "304-589-3251",
            "fax_number": "304-589-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5451 SIMMONS RIVER ROAD",
            "city": "MONTCALM",
            "state": "WV",
            "postal_code": "24737",
            "telephone_number": "304-589-3251",
            "fax_number": "304-589-5363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESTONE HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A",
        "authorized_official_last_name": "HUTCHENS",
        "authorized_official_first_name": "BRITTANI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-320-2835",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prudich Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prudich Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montcalm, WV

Sources for this page

Verify at the official NPI Registry.