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 Bridgeport

Practice address

100 Market PL
Bridgeport, WV 26330-9168

Phone

(304) 848-5770

Fax

(304) 848-0890

NPI assigned

Apr 13, 2015

Last updated

Apr 26, 2024By the provider in NPPES

Organization subpart

No

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 Bridgeport 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 1063808418. Details of each certification follow.

• CCN 511068 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 511068

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

COMMUNITY CARE OF BRIDGEPORT II

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 29, 2015

Last certification

Apr 29, 2015

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

100 Market PL
Bridgeport, WV 26330-9168

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 58

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.

• Jill Nicole Strasser, MSN, APRN, FNP-BC

  • Nurse Practitioner
  • Bridgeport, WV
  • NPI 1083959803
  Medicare reassignment Care Compare group NPD
• Joshua Steven Baker, PAC

  • Physician Assistant
  • West Milford, WV
  • NPI 1003897497
  Medicare reassignment NPD
• Nicholas Joel Baker, PA-C

  • Physician Assistant
  • Buckhannon, WV
  • NPI 1225177504
  Medicare reassignment NPD
• Meenal Balakrishnan, DO

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1528694411
  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
• Richard Cadenas

  • Psychiatry Physician
  • Morgantown, WV
  • NPI 1295312601
  Medicare reassignment NPD
• Kathleen Gray Chaney, LGSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1841856739
  Medicare reassignment NPD
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760
  Medicare reassignment NPD
• Betsy Coulter, LICSW

  • Clinical Social Worker
  • Sutton, WV
  • NPI 1205312329
  Medicare reassignment NPD
• Naomi Crickenberger, LICSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1376266775
  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": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1063808418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MARKET PL",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309168",
            "telephone_number": "304-848-5770",
            "fax_number": "304-848-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARKET PL",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309168",
            "telephone_number": "304-848-5770",
            "fax_number": "304-848-0890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Kidd Ave",
            "address_purpose": "LOCATION",
            "city": "Stonewood",
            "state": "WV",
            "postal_code": "263014833",
            "country_code": "US",
            "telephone_number": "304-326-7050",
            "fax_number": "304-587-2594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "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 Bridgeport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanner Grant Cole, FNP-C
• Dawn M Colley, LSW
• Jeffery S Collins, MA
• David Forrest Colvin, MD
• Community Care of West Virginia
• Community Care of West Virginia, Inc. (Community Care of Bridgeport)
• Community Care of West Virginia, Inc. (Bridgeport High School Wellness Center)
• Community Care of West Virginia, Inc. (Community Care of Bridgeport)
• Community Care of West Virginia, Inc. (Community Care Pharmacy of Bridgeport)
• Community Care of West Virginia, Inc. (Bridgeport Middle School Wellness Center)

• Federally Qualified Health Center (FQHC) in Bridgeport, WV
• Providers in Bridgeport, 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 Apr 26, 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.