Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

Community Care of Clarksburg

Practice address

700 Oakmound Rd
Clarksburg, WV 26301-9398

Phone

(304) 924-6262

Fax

(304) 924-5460

NPI assigned

Dec 6, 2013

Last updated

Jan 19, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

COMMUNITY CARE OF WEST VIRGINIA, INC.As reported in NPPES

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

Authorized official

Name

Dora L Potasnik

Title

Credentialing

Phone

(304) 587-2541

Specialties & licenses 1

Addresses

Other names 1

• Community Care of Clarksburg Doing business as

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053742668. Details of each certification follow.

• CCN 511045 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 511045

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

COMMUNITY CARE OF CLARKSBURG

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 25, 2014

Last certification

Feb 25, 2014

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

700 Oakmound Rd
Clarksburg, WV 26301-9398

Part of

Community Care of West Virginia

All disclosed owners & managing parties 22

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

Owners & managing parties with NPI records 3

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

• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863

  Corporate Officer

  CMS ownership
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760

  Corporate Officer

  CMS ownership
• Kevin Douglas Junkins, MD

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1629344858

  Corporate Officer

  CMS ownership

All facility ownership & control disclosures 1

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

Practitioners 62

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.

• Evan Stalnaker, MD

  • Family Medicine Physician
  • Washington, PA
  • NPI 1538808233

  WV

  Medicare reassignment Care Compare group NPD
• Jennifer Abel, FNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Buckhannon, WV
  • NPI 1396152740
  Medicare reassignment NPD
• Nicholas Joel Baker, PA-C

  • Physician Assistant
  • Buckhannon, WV
  • NPI 1225177504
  Medicare reassignment NPD
• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863
  Medicare reassignment NPD
• Sarah Bell, DNP

  • Family Nurse Practitioner
  • Weston, WV
  • NPI 1841706884
  Medicare reassignment NPD
• Angela Gayle Carter, APRN, BC

  • Family Nurse Practitioner
  • Clay, WV
  • NPI 1083806277
  Medicare reassignment NPD
• Sarah B Chouinard, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1023087954
  Medicare reassignment NPD
• Rachel Ann Clemens, FNP

  • Family Nurse Practitioner
  • Weston, WV
  • NPI 1952855686
  Medicare reassignment NPD
• Diana Lynn Cooper, FNP-C

  • Family Nurse Practitioner
  • Weston, WV
  • NPI 1356969927
  Medicare reassignment NPD
• Betsy Coulter, LICSW

  • Clinical Social Worker
  • Sutton, WV
  • NPI 1205312329
  Medicare reassignment NPD
• Ashley Curry

  • Counselor
  • Clarksburg, WV
  • NPI 1871173476
  Medicare reassignment NPD
• Penny N Cutlip, FNP

  • Nurse Practitioner
  • Elkins, WV
  • NPI 1972237857
  Medicare reassignment NPD

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1053742668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OAKMOUND RD",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263019398",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "enumeration_date": "2013-12-06",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "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": "Community Care of Clarksburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kayla R Collins
• Ashley Taylor Combs, LPN
• Shannon Commodore, PHARM D.
• Community Care of West Virginia (Community Care Pharmacy of Clarksburg)
• Community Care of West Virginia Inc (Adamston Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Mountaineer Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Liberty Middle School Wellness Center)
• Community Care of West Virginia, Inc. (North View Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Robert C. Byrd High Wellness Center)
• Community Care of West Virginia, Inc. (Alternative Learning Center Wellness Center)

• Federally Qualified Health Center (FQHC) in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Federally Qualified Health Center (FQHC) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.