NPIMap

Organization Active NPI

Valley Professionals Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Crawfordsville, IN
National Provider Identifier
1083009997
Registry record updated Dec 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Practice address
1702 Lafayette Rd
Crawfordsville, IN 47933-1033
Phone
(765) 625-5100
Fax
(765) 281-1030
NPI assigned
Mar 30, 2015
Last updated
Dec 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2018

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

Authorized official

Name
Terry Warren
Title
Ceo
Phone
(260) 969-6598

Specialties & licenses 1

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

Addresses

Primary practice location

1702 Lafayette Rd
Crawfordsville, IN 47933-1033

Mailing address

1702 Lafayette Rd
Crawfordsville, IN 47933-1033
Phone (765) 625-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071219000487 IN Part B Supplier - Clinic/Group Practice 7618067265 Receives reassigned benefits from 94 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Terre Haute, IN; Terre Haute, IN; Rockville, IN; Clinton, IN; Crawfordsville, IN; Bloomingdale, IN; Cayuga, IN
O20150728003485 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618067265 Practice locations: Crawfordsville, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083009997. Details of each certification follow.

Federally qualified health center certification: CCN 151949

Legal name
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Doing business as
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 16, 2015
Last certification
Jul 16, 2015
Ownership / control type
For profit – partnership
Organization structure
OtherNon-profit
Enrollment address
1702 Lafayette Rd
Crawfordsville, IN 47933-1033

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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
15D2221798Valley Professionals Community Health Center -1702 Lafayette Rd, Crawfordsville, IN 47933Provider-performed microscopyApr 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Valley Professionals Community Health Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Interoperability endpoints

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Mary Helderman Individual Corporate Director Jan 1, 2022
Loretta Johnson Individual Corporate Director Jan 1, 2022
Jacqueline Mathis Individual Corporate Officer Jan 1, 2024
David Allen Chapman Individual Corporate DirectorBoard Member Feb 1, 2020
Terry J Warren Individual Corporate DirectorCeo Sep 22, 2008
W-2 Managing EmployeeCeo Jun 28, 2015
Michael Miller Individual Corporate Officer Jan 1, 2024
Kristin Craig Individual Corporate DirectorBoard Member Feb 1, 2020
Mark Russell Individual Corporate Director Jan 1, 2021 6%
Ronald Hodge Individual Corporate Director Jan 1, 2023
Marina Wolfe Individual Corporate Director Jan 1, 2023
John Michael Major Individual Corporate Director Jan 1, 2022
Danielle M Cundiff Individual Corporate Officer Sep 1, 2022
W-2 Managing Employee Sep 1, 2022
Louis Bonomo Individual Corporate Officer Mar 7, 2025
Jessica Marie Purcell Individual Corporate Director Jan 1, 2022
Jill Pastore Individual Corporate DirectorBoard Member Feb 1, 2020
Christopher M Williams Individual Corporate Director Jan 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1427673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1083009997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 LAFAYETTE RD",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331033",
            "telephone_number": "765-625-5100",
            "fax_number": "765-281-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 LAFAYETTE RD",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479331033",
            "telephone_number": "765-625-5100",
            "fax_number": "765-281-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-30",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-969-6598"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crawfordsville, IN

Sources for this page

Verify at the official NPI Registry.