NPIMap

Organization Active NPI

Potomac Valley Hospital of W VA, Inc

Doing business as Riverside Clinic

  • Rural Health Clinic/Center
  • Piedmont, WV
National Provider Identifier
1063649606
Registry record updated Apr 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
POTOMAC VALLEY HOSPITAL OF W VA, INC
Doing business as
Riverside Clinic
Practice address
122 Ashfield St
Piedmont, WV 26750-1300
Phone
(304) 355-2323
NPI assigned
Jun 22, 2009
Last updated
Apr 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2010

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

Authorized official

Name
Mr. Harold A McBee
Title
Owner
Phone
(410) 643-3393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

122 Ashfield St
Piedmont, WV 26750-1300

Mailing address

100 Pin Oak LN
Keyser, WV 26726-5908
Phone (304) 597-3500

Other names 1

  • RIVERSIDE CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090701000399 WV Part A Provider - Rural Health Clinic 8123917788 Practice locations: Piedmont, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063649606. Details of each certification follow.

Rural health clinic certification: CCN 513414

Legal name
POTOMAC VALLEY HOSPITAL OF W VA , INC
Doing business as
RIVERSIDE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 8, 2010
Last certification
Dec 10, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1958 in WV
Enrollment address
32 2ND St
Piedmont, WV 26750-1024
Related CCNs
511315

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0236938Riverside Rural Health Clinic32 2ND St, Piedmont, WV 26750Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Potomac Valley Hospital28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

122 Ashfield St
Piedmont, WV 26750
Phone (304) 355-2323

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
Jerry E Whisner Individual Corporate OfficerPresident Apr 3, 2014
Michael Joseph Gould Individual Corporate Director Aug 10, 2021
Marjorie S Fridkin Individual Corporate Director Sep 21, 2023
Kevin Clark Individual Corporate Director Mar 27, 2018
Dinah Courrier Individual Corporate Director Nov 20, 2019
Lewis Kitzmiller Individual Corporate Director Jul 20, 2022
West Virginia United Health System, Inc Organization, Morgantown, WV Corporation, Non-profit Operational/Managerial Control Jan 1, 2005 100%
Mark Boucot Individual Corporate Director Jan 1, 2018
W-2 Managing EmployeeCeo Jan 1, 2018
Harshad S Bokil Individual Corporate Director Sep 21, 2023
Frances L Jones Individual Corporate Director Nov 27, 2018
Sue a Wells Individual W-2 Managing EmployeeDirector Business Office Apr 3, 2014
Robin Haupt Individual Corporate Director Sep 1, 2017

Owners & managing parties with NPI records 3

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 2

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": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270425600000",
    "number": "1063649606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PIN OAK LN",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267265908",
            "telephone_number": "304-597-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 ASHFIELD ST",
            "city": "PIEDMONT",
            "state": "WV",
            "postal_code": "267501300",
            "telephone_number": "304-355-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC VALLEY HOSPITAL OF W VA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2010-04-05",
        "status": "A",
        "authorized_official_last_name": "MCBEE",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-643-3393",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RIVERSIDE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Piedmont, WV

Sources for this page

Verify at the official NPI Registry.