NPIMap

Organization Active NPI

Community Health Systems Inc.

  • Federally Qualified Health Center (FQHC)
  • Fayetteville, WV
National Provider Identifier
1073506465
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH SYSTEMS INC.
Practice address
5493 Maple LN
Fayetteville, WV 25840-6872
Phone
(304) 469-3334
Fax
(304) 465-1735
NPI assigned
Aug 31, 2005
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Mr. Charles Hunt I
Title
Ceo
Phone
(304) 252-2324

Specialties & licenses 1

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

Addresses

Primary practice location

5493 Maple LN
Fayetteville, WV 25840-6872

Mailing address

252 Rural Acres Dr.
Beckley, WV 25801
Phone (304) 252-8324

Other identifiers 1

IdentifierTypeStateIssuer
CO5119301OtherWVMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311000504 WV Part B Supplier - Public Health/Welfare Agency 6608785795 Receives reassigned benefits from 106 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beckley, WV
O20070815000133 WV Part A Provider - Federally Qualified Health Center (FQHC) 6608785795 Practice locations: Fayetteville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073506465. Details of each certification follow.

Federally qualified health center certification: CCN 511930

Legal name
COMMUNITY HEALTH SYSTEMS INC
Doing business as
ACCESS HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 9, 2007
Last certification
Oct 9, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1967 in WV
Enrollment address
5493 Maple LN
Fayetteville, WV 25840-6872

Other NPIs on the same Medicare enrollment 10

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

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
51D0235398Access Health Fayette Clinic5493 Maple Lane, Fayetteville, WV 25840Certificate of waiverDec 12, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Carl Bowman Individual Corporate Director Aug 6, 2007
Chris Davis Individual Corporate Director Aug 6, 2007
Carolyn Dilorenzo Individual Corporate Director Aug 6, 2007
Gregory Hazuka Individual Corporate Director Aug 6, 2007
Charles Hunt Individual Corporate OfficerCeo Apr 17, 2000
W-2 Managing Employee Aug 6, 2007
Operational/Managerial Control Aug 6, 2007

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Access HealthWelch, WV, CCN 511151 Federally qualified health center Operational/Managerial Control Aug 25, 2017
Community Health Systems IncBeckley, WV, CCN 511159 Federally qualified health center Operational/Managerial Control Oct 1, 2018
AccesshealthBeckley, WV, CCN 511175 Federally qualified health center Operational/Managerial Control Aug 1, 2019
Accesshealth Daniels Elementary SchoolDaniels, WV, CCN 511180 Federally qualified health center Operational/Managerial Control Apr 17, 2000
Community Health Systems IncBeckley, WV, CCN 581840 Federally qualified health center Operational/Managerial Control Apr 17, 2000
Accesshealth Stratton ElementaryBeckley, WV, CCN 581072 Federally qualified health center Operational/Managerial Control Oct 31, 2023

Practitioners & affiliated clinicians

Practitioners 6

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": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1073506465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 RURAL ACRES DR.",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "25801",
            "telephone_number": "304-252-8324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5493 MAPLE LN",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258406872",
            "telephone_number": "304-469-3334",
            "fax_number": "304-465-1735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH SYSTEMS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-252-2324",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "I"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CO5119301",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, WV

Sources for this page

Verify at the official NPI Registry.