Wirt County Health Services Association Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Ripley, WV
NPI 1043401730 · NPPES record last updated Jan 3, 2014
Key facts
- NPI
- 1043401730
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WIRT COUNTY HEALTH SERVICES ASSOCIATION INC
- Practice address
- 512A South Church Street
Ripley, WV 25271-9710 - Phone
- (304) 372-1033
- Fax
- (304) 372-0223
- NPI assigned
- Aug 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Vicki L. Knicely
- Title
- Billing/Credentialing Supervisor
- Phone
- (304) 275-3301
Owners & managing parties with NPI records 11
-
David M Schenkelberg, MA,, LPCC
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 10
Facilities with the same owner 1
Practitioners 56
-
Ashley M Blanc, MA
-
Miranda Sue Boso, C-FNP
-
Richard Edward Cain, M.D.
-
Deborah Ann Casdorph, FNP
-
Sarah L. Casseday, LPC
-
Erica Elaine Conant, FNP
-
Nancy Rose Creighton, LPC, ALPS
-
Elizabeth Cruger, LPC
-
Rachael Yoder Jarvis, LICSW
-
Heather J Kay, CFNP
-
Lindsey A. Keeney, PA-C
-
Charlotte L Lantz, CFNP
-
Stacey N Mills, C-FNP
-
Shirin M Morad, DO
-
Cami Myers, FNP-C
-
Darrin Earl Nichols, M.D.
-
Mary Frances Treadway, FNP-BC
-
Kenna Lea Wagner, MSN, APRN, FNP-BC
-
Richard W Watson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
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
- Corporation · Non-profit
- Incorporated
- Jul 17, 1978 in WV
- Enrollment address
- 512A Church S St
Ripley, WV 25271-1616
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Carol Brown |
Corporate Officer |
Jan 1, 2015 | |
| Donald Brookover |
Corporate Director | Sep 1, 2007 | |
| Treva Full |
Corporate Director | Jan 1, 2015 | |
| Albert Roy Buchanan |
Corporate Director | Sep 1, 2007 | |
| Robert Gunnoe |
Corporate Director | Jan 1, 2015 | |
| Berkley Simmons |
Corporate Director | Dec 1, 2014 | |
| James Frazier |
Corporate Director | Jan 1, 2015 | |
| Melissa Weekley |
Corporate Director | Jul 1, 2013 | |
| David M Schenkelberg |
Corporate Director | Jan 1, 2015 | |
| Judy Cline |
Corporate Director | Sep 1, 2007 | |
| Wirt County Health Services Association, Inc |
Operational/Managerial Control | Jul 17, 1978 | |
| Vicki Knicely |
W-2 Managing Employee |
Mar 1, 2002 | |
| Cheryl Samblanet |
Corporate Director | Jan 1, 2015 | |
| Douglas Full |
Corporate Director | Jan 1, 2015 | |
| Rob Dudley |
Corporate Officer |
Sep 10, 2018 | |
| W-2 Managing Employee | Sep 10, 2018 | ||
| Anessa Dille |
W-2 Managing Employee |
Jul 1, 2014 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Wirt County Health Services Association, Inc |
Federally qualified health center | Operational/Managerial Control | Oct 13, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009486002 | Medicaid | WV |
Other names
- Ripley Family Medicine
Other providers in Ripley, WV
- Daniel Owen Whyte
- Leann McKay Williams
- Matthew Williams
- Robert J Williamson
- Charlene Wilson
- Wirt County Health Services Association, Inc
- Wirt County Health SVC Assoc Inc
- Evelyn Jolie Withrow
- Monica Withrow
- Ashley Wolfe
All providers in Ripley, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2014. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.