NPIMap

Organization Active NPI

Valley Health Systems Inc

Doing business as Valley Health Fort Gay

  • Federally Qualified Health Center (FQHC)
  • Fort Gay, WV
National Provider Identifier
1083694756
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY HEALTH SYSTEMS INC
Doing business as
Valley Health Fort Gay
Practice address
71 Wayne St
Fort Gay, WV 25514
Phone
(304) 648-5544
Fax
(304) 648-5989
NPI assigned
Jan 19, 2006
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mary-Beth Brubeck
Title
Vice President of Finance / Cfo
Phone
(304) 525-3334

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Psychologist 103T00000X WV
Dentist 122300000X 2768 WV
Family Medicine Physician 207Q00000X 1744 WV
Federally Qualified Health Center (FQHC) 261QF0400X WV Primary
Physician Assistant 363A00000X WV
Family Nurse Practitioner 363LF0000X WV

Addresses

Primary practice location

71 Wayne St
Fort Gay, WV 25514

Mailing address

2585 3Rd Ave
Huntington, WV 25703-1642
Phone (304) 697-1396

Other identifiers 7

IdentifierTypeStateIssuer
0035071000MedicaidWV
61900841MedicaidKY
614938702OtherWVBLACK LUNG
65916702MedicaidKY
6593981100MedicaidKY
CJ2698OtherWVRR MEDICARE GROUP
2752543MedicaidOH

Other names 1

  • Valley Health Fort Gay Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325000411 WV Part B Supplier - Public Health/Welfare Agency 9931017969 Receives reassigned benefits from 154 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Huntington, WV; Wayne, WV; Ona, WV; Kermit, WV; Hurricane, WV; Harts, WV; Fort Gay, WV; Cedar Grove, WV
O20100927000663 WV Part A Provider - Federally Qualified Health Center (FQHC) 9931017969 Practice locations: Fort Gay, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083694756. Details of each certification follow.

Federally qualified health center certification: CCN 511805

Legal name
VALLEY HEALTH SYSTEMS, INC
Doing business as
VALLEY HEALTH FORT GAY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1993 in WV
Enrollment address
71 Wayne St
Fort Gay, WV 25514-8518

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

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
Sherry Perry Individual Corporate Director Jan 1, 2010
Christina Walter Individual Corporate DirectorBoard Member Apr 25, 2019
Jared Colker Individual Corporate DirectorBoard Member Dec 8, 2016
Debra Zuberbuehler Individual Corporate DirectorBoard Member Jan 1, 2025
Paulette Mabry Individual Corporate DirectorBoard Member Dec 8, 2015
Bill Bryant Individual Corporate DirectorBoard Member Apr 28, 2011
Suzi Brodof Individual Corporate DirectorBoard Member Oct 26, 2017
Mathew Weimer Individual Corporate OfficerPresident, Ceo Sep 28, 2024
W-2 Managing Employee Sep 28, 2024
Sherrone Hornbuckle Individual Corporate DirectorBoard Member Oct 26, 2017
Mary-Beth Brubeck Individual Corporate OfficerExecutive Vice President / Cfo Jan 1, 2019
Kalyn Obiozor Dorey Individual Corporate Director Nov 22, 2022
Greg Agee Individual Corporate Director Jan 1, 2010
Xavier Staggs Individual Corporate DirectorBoard Member Jan 1, 2025
Benjamin L Howard Individual Corporate Director Jan 1, 2010

Owners & managing parties with NPI records 1

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
Valley Health Apple GroveApple Grove, WV, CCN 581056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 16, 1975
Valley Health SCP - Charleston 108Charleston, WV, CCN 581062 Federally qualified health center Operational/Managerial Control Feb 1, 2024

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1083694756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2585 3RD AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257031642",
            "telephone_number": "304-697-1396",
            "fax_number": "304-697-2086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 WAYNE ST",
            "city": "FORT GAY",
            "state": "WV",
            "postal_code": "25514",
            "telephone_number": "304-648-5544",
            "fax_number": "304-648-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "BRUBECK",
        "authorized_official_first_name": "MARY-BETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE / CFO",
        "authorized_official_telephone_number": "304-525-3334"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "2768",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1744",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035071000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61900841",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "614938702",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65916702",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6593981100",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CJ2698",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2752543",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health Fort Gay",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health Fort Gay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Gay, WV

Sources for this page

Verify at the official NPI Registry.