NPIMap

Organization Active NPI

Wirt County Health Services Association Inc

Doing business as Ripley Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Ripley, WV
National Provider Identifier
1043401730
Registry record updated Jan 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WIRT COUNTY HEALTH SERVICES ASSOCIATION INC
Doing business as
Ripley Family Medicine
Practice address
512A South Church Street
Ripley, WV 25271-9710
Phone
(304) 372-1033
Fax
(304) 372-0223
NPI assigned
Aug 7, 2007
Last updated
Jan 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2014

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

Authorized official

Name
Vicki L. Knicely
Title
Billing/Credentialing Supervisor
Phone
(304) 275-3301

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

512A South Church Street
Ripley, WV 25271-9710

Mailing address

PO Box 609
Elizabeth, WV 26143-0609
Phone (304) 275-3301

Other identifiers 1

IdentifierTypeStateIssuer
0009486002MedicaidWV

Other names 1

  • Ripley Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071011000460 WV Part A Provider - Federally Qualified Health Center (FQHC) 7810806577 Practice locations: Ripley, WV
O20080602000050 WV Part B Supplier - Public Health/Welfare Agency 7810806577 Receives reassigned benefits from 49 practitioners
2 other NPIs on this enrollment
Practice locations: Elizabeth, WV; Ravenswood, WV; Ripley, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043401730. Details of each certification follow.

Federally qualified health center certification: CCN 511933

Legal name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
RIPLEY FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 18, 2008
Last certification
Jan 18, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 1978 in WV
Enrollment address
512A Church S St
Ripley, WV 25271-1616

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Carol Brown Individual Corporate OfficerPresident of Board Jan 1, 2015
Donald Brookover Individual Corporate Director Sep 1, 2007
Treva Full Individual Corporate Director Jan 1, 2015
Albert Roy Buchanan Individual Corporate Director Sep 1, 2007
Robert Gunnoe Individual Corporate Director Jan 1, 2015
Berkley Simmons Individual Corporate Director Dec 1, 2014
James Frazier Individual Corporate Director Jan 1, 2015
Melissa Weekley Individual Corporate Director Jul 1, 2013
David M Schenkelberg Individual Corporate Director Jan 1, 2015
Judy Cline Individual Corporate Director Sep 1, 2007
Wirt County Health Services Association, Inc Organization, Elizabeth, WV Corporation Operational/Managerial Control Jul 17, 1978
Vicki Knicely Individual W-2 Managing EmployeeOffice Manager Mar 1, 2002
Cheryl Samblanet Individual Corporate Director Jan 1, 2015
Douglas Full Individual Corporate Director Jan 1, 2015
Rob Dudley Individual Corporate OfficerCeo Sep 10, 2018
W-2 Managing Employee Sep 10, 2018
Anessa Dille Individual W-2 Managing EmployeeCredentialing Supervisor Jul 1, 2014

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Wirt County Health Services Association, IncParkersburg, WV, CCN 581818 Federally qualified health center Operational/Managerial Control Oct 13, 2021

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 55

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 55

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388707200000",
    "number": "1043401730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "ELIZABETH",
            "state": "WV",
            "postal_code": "261430609",
            "telephone_number": "304-275-3301",
            "fax_number": "304-275-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512A SOUTH CHURCH STREET",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252719710",
            "telephone_number": "304-372-1033",
            "fax_number": "304-372-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIRT COUNTY HEALTH SERVICES ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2014-01-03",
        "status": "A",
        "authorized_official_last_name": "KNICELY",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "304-275-3301"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009486002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ripley Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ripley, WV

Sources for this page

Verify at the official NPI Registry.