NPIMap

Organization Active NPI

Tri Area Community Health

Doing business as Tri Area Community Health at Ferrum

  • Federally Qualified Health Center (FQHC)
  • Ferrum, VA
National Provider Identifier
1053442848
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI AREA COMMUNITY HEALTH
Doing business as
Tri Area Community Health at Ferrum
Practice address
180 Ferrum Mountain Rd
Ferrum, VA 24088-2939
Phone
(540) 365-4469
Fax
(540) 365-4272
NPI assigned
Mar 7, 2007
Last updated
Jan 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

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

Authorized official

Name
James Werth Jr.
Title
Executive Director
Phone
(276) 398-2292

Specialties & licenses 1

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

Addresses

Primary practice location

180 Ferrum Mountain Rd
Ferrum, VA 24088-2939

Mailing address

PO Box 9
Laurel Fork, VA 24352-0009
Phone (276) 398-2292

Other identifiers 2

IdentifierTypeStateIssuer
010355125MedicaidVA
1053442848MedicaidVA

Other names 1

  • Tri Area Community Health at Ferrum Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040122000969 VA Part B Supplier - Clinic/Group Practice 6204748296 Receives reassigned benefits from 46 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Independence, VA; Troutdale, VA; Stuart, VA; Laurel Fork, VA; Hillsville, VA; Galax, VA; Fries, VA; Floyd, VA…
O20061120000384 VA Part A Provider - Federally Qualified Health Center (FQHC) 6204748296 1 other NPI on this enrollment
Practice locations: Ferrum, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053442848. Details of each certification follow.

Federally qualified health center certification: CCN 491872

Legal name
TRI AREA COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2007
Last certification
Jan 24, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 31, 1980 in VA
Enrollment address
180 Ferrum Mountain Road
Ferrum, VA 24088

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

100 Cavs Ln
Hillsville, VA 24343
Phone (888) 908-4788

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Delia Heck Individual Corporate DirectorBoardmember Jan 1, 2017
Jason Wood Individual Corporate DirectorBoardmember Jan 1, 2016
Stephen Puckett Individual Corporate DirectorBoardmember Jan 1, 2017
James L Werth Individual Corporate Officer Jun 24, 2019
W-2 Managing Employee Jun 24, 2019
Nancy Puckett Individual W-2 Managing EmployeeAccounts Receivable Manager Aug 14, 2006
James Houchins Individual Corporate Director Jan 1, 2016
Lorene Becker Individual Corporate DirectorBoardmember Jan 1, 2018
Brenda Hopkins Individual Corporate DirectorBoardmember Jan 1, 2017
Jason Phillips Individual Corporate Director Jan 1, 2018
Kayla a Boyd Individual Corporate Officer Dec 1, 2015
W-2 Managing Employee Dec 1, 2015
Chip Phillips Individual Corporate DirectorBoardmember Jan 1, 2013
Julian Webb Individual Corporate DirectorBoard Member Jan 1, 2011

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tri Area Community HealthFries, VA, CCN 491010 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 7, 2022

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1053442848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "LAUREL FORK",
            "state": "VA",
            "postal_code": "243520009",
            "telephone_number": "276-398-2292",
            "fax_number": "276-398-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 FERRUM MOUNTAIN RD",
            "city": "FERRUM",
            "state": "VA",
            "postal_code": "240882939",
            "telephone_number": "540-365-4469",
            "fax_number": "540-365-4272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI AREA COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "WERTH",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "276-398-2292",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010355125",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053442848",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri Area Community Health at Ferrum",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tri Area Community Health at Ferrum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ferrum, VA

Sources for this page

Verify at the official NPI Registry.