NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

Doing business as CareXpress of Weston

  • Federally Qualified Health Center (FQHC)
  • Weston, WV
National Provider Identifier
1073944658
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
CareXpress of Weston
Practice address
149 Staunton Drive
Weston, WV 26452
Phone
(304) 924-6262
Fax
(304) 924-5460
NPI assigned
Dec 6, 2013
Last updated
Jan 31, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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) 317-7275

Specialties & licenses 1

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

Addresses

Primary practice location

149 Staunton Drive
Weston, WV 26452

Mailing address

149 Staunton Dr
Weston, WV 26452-5604
Phone (304) 269-5510

Other names 1

  • CareXpress of Weston Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131227001130 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Weston, WV
O20140320000490 WV Part B Supplier - Clinic/Group Practice 0446232987 Receives reassigned benefits from 69 practitioners
Practice locations: Weston, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073944658. Details of each certification follow.

Federally qualified health center certification: CCN 511040

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
CAREXPRESS OF WESTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 27, 2013
Last certification
Dec 27, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
149 Staunton Dr
Weston, WV 26452-5604

National Provider Directory

National Provider Directory
Part of
Tri County Health Clinic Inc

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Dora L. Potasnik Individual W-2 Managing EmployeeCredentialing Coordinator Jan 9, 2012
Kristi Walkr Individual Corporate OfficerCoo Oct 15, 2022
Juston Chad Morrison Individual Corporate Director Apr 10, 2017
Hillary Nicole Tenney Individual W-2 Managing EmployeeCredentialing Coordinator Aug 1, 2019
Elisabeth M Samples Individual Corporate DirectorBoard Secretary Jan 1, 2018
Michele Williams Individual Corporate OfficerCompliance Officer Dec 12, 2005
Jeffrey Jenkins Individual Corporate OfficerCfo Apr 4, 2022
Richard G Simon Individual Corporate OfficerCeo Sep 13, 1993 100%
David B Malcomb Individual Corporate Director Jan 1, 2018
Selah Raines Individual Corporate Director Jan 1, 2020
David D Taylor Individual Corporate Director Mar 14, 2016
Katherine Anne Horner Individual Corporate DirectorBoard Vice- President Jan 14, 2019
Kimberly Renee Becher Individual Corporate OfficerChief Medical Officer Sep 23, 2021
Patricia Louise Collett Individual Corporate OfficerDeputy Ceo Nov 18, 2000
Steven Roy Flaughers Individual Corporate Director Jan 14, 2019
Rosemary M Thomas Individual Corporate DirectorBoard President Jan 1, 2020
James L Estep Individual Corporate DirectorBoard Treasurer Jan 1, 2020
Sarina Smith Individual Corporate Director Jan 14, 2019

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 1

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

FacilityTypeRoleSince
West Virginia Wesleyan College Wellness CenterBuckhannon, WV, CCN 511146 Federally qualified health center Operational/Managerial Control (100%) May 21, 2018

Practitioners & affiliated clinicians

Practitioners 109

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.

View all 109

NPI Registry JSON

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1073944658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 STAUNTON DR",
            "city": "WESTON",
            "state": "WV",
            "postal_code": "264525604",
            "telephone_number": "304-269-5510",
            "fax_number": "304-269-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 STAUNTON DRIVE",
            "city": "WESTON",
            "state": "WV",
            "postal_code": "26452",
            "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": "2025-01-31",
        "certification_date": "2025-01-31",
        "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": "304-317-7275"
    },
    "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": "CareXpress of Weston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Weston, WV

Sources for this page

Verify at the official NPI Registry.