NPIMap

Organization Active NPI

Southwest Virginia Community Health Systems Inc.

Doing business as Virginia High School

  • Federally Qualified Health Center (FQHC)
  • Bristol, VA
National Provider Identifier
1073279170
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC.
Doing business as
Virginia High School
Practice address
650 Long Crescent Dr
Bristol, VA 24201-3690
Phone
(276) 496-4492
NPI assigned
Nov 12, 2021
Last updated
Nov 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Authorized official

Name
Joseph Bryan Haynes
Title
Ceo
Phone
(276) 496-4492

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Student Health Clinic/Center 261QS1000X NU

Addresses

Primary practice location

650 Long Crescent Dr
Bristol, VA 24201-3690

Mailing address

PO Box 297
Meadowview, VA 24361-0297
Phone (276) 496-4492

Other names 1

  • Virginia High School Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000290 VA Part B Supplier - Clinic/Group Practice 4880502707 Receives reassigned benefits from 33 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tazewell, VA; Saltville, VA; Meadowview, VA; Chilhowie, VA; Bristol, VA
O20220322002407 VA Part A Provider - Federally Qualified Health Center (FQHC) 4880502707 Practice locations: Bristol, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073279170. Details of each certification follow.

Federally qualified health center certification: CCN 491988

Legal name
SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC
Doing business as
VIRGINIA HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 2, 2022
Last certification
Mar 2, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 2001 in VA
Enrollment address
650 Long Crescent Dr
Bristol, VA 24201-3690

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 15

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

View all 15

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
49D2266867Virginia High School Based Clinic650 Long Crescent Dr, Bristol, VA 24201Certificate of waiverAug 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Southwest Virginia Community Health Systems Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HCCDAA

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Harold M. Leake Individual Corporate DirectorBoard Secretary Mar 1, 2012
Joseph Haynes Individual W-2 Managing EmployeeCeo Sep 26, 2011
Linda G Mullins Individual Corporate DirectorBoard Member Mar 18, 2019
Victoria Davidson Individual Corporate DirectorBoard Member Dec 14, 2006
Chad Brown Individual W-2 Managing EmployeeChief Operations Officer Jan 1, 2018
Steven Hylton Individual Corporate DirectorVice Chair Feb 15, 2016
Jean Chapman Individual Corporate DirectorBoard Chair Feb 15, 2018
Roberta Hylton Individual Corporate DirectorBoard Member Apr 19, 2021
George H Washington Individual Corporate DirectorBoard Member Mar 24, 2014
Kristin O Bresowar Individual W-2 Managing EmployeeMedical Director Aug 18, 2014
Mark Ensminger Individual Corporate DirectorBoard Treasurer Feb 15, 2017
Norah Ann Nutter Individual Corporate DirectorBoard Member Jan 21, 2019
Patricia Fullen Individual Corporate DirectorBoard Member Sep 17, 2018
Robert Ashley Individual Corporate DirectorBoard Member Nov 16, 2020

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Chilhowie High SchoolChilhowie, VA, CCN 491023 Federally qualified health center Operational/Managerial Control (100%) Feb 29, 2024
High Point Elementary SchoolBristol, VA, CCN 491040 Federally qualified health center Operational/Managerial Control (100%) Oct 15, 2024

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1636675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636675200000",
    "number": "1073279170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 297",
            "city": "MEADOWVIEW",
            "state": "VA",
            "postal_code": "243610297",
            "telephone_number": "276-496-4492",
            "fax_number": "276-695-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 LONG CRESCENT DR",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242013690",
            "telephone_number": "276-496-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-12",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "276-496-4492"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virginia High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bristol, VA

Sources for this page

Verify at the official NPI Registry.