NPIMap

Organization Active NPI

Rainelle Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rainelle, WV
National Provider Identifier
1093199036
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RAINELLE MEDICAL CENTER, INC.
Practice address
205 Medical Center Drive
Rainelle, WV 25962-1064
Phone
(304) 438-1922
Fax
(304) 438-1921
NPI assigned
Jul 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Debra J Bennett
Title
Credentialing Specialist
Phone
(304) 438-6188

Specialties & licenses 1

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

Addresses

Primary practice location

205 Medical Center Drive
Rainelle, WV 25962-1064

Mailing address

176 Medical Center Dr
Rainelle, WV 25962-1064
Phone (304) 438-6188

Other names 1

  • RAINELLE MEDICAL/DENTAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161122001136 WV Part A Provider - Federally Qualified Health Center (FQHC) 7416861810 Practice locations: Rainelle, WV

Federally qualified health center certification: CCN 511118

Legal name
RAINELLE MEDICAL CENTER INC
Doing business as
RAINELLE MEDICAL/DENTAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Nov 13, 1988 in WV
Enrollment address
205 Medical Center Dr
Rainelle, WV 25962-1064

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Rupert Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the 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
Davida Farley Individual Corporate Director Jan 1, 2006
Stephen Baldwin Individual Corporate OfficerBoard Member Jan 1, 2022
Kristi Atha-Rader Individual W-2 Managing EmployeeCeo Jun 30, 2008
Gary G Veronneau Individual Corporate Director Jan 1, 2013
Elizabeth Campbell Individual Corporate DirectorBoard Member Jan 1, 2022
Kimberly Howard Individual Corporate Director Jan 1, 2006
Ron Fleshman Individual Corporate Director Jan 1, 2006
Barry Crist Individual Corporate DirectorBoard Member Jan 1, 2022
Debra J Bennett Individual Corporate DirectorDirector of Credentialing Jan 4, 1999
Nina Blankenship Individual Corporate OfficerBoard Member Jan 1, 2022
Christopher Clay Individual Contracted Managing EmployeeCfo Dec 15, 2008
Henry Bivens Individual Corporate OfficerBoard Member Jan 1, 2022
Jessie Boone Individual Corporate OfficerBoard Member Jan 1, 2022
Frank Mullins Individual Corporate Director Jan 1, 2015

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 4

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

FacilityTypeRoleSince
Midland Trail Health CenterHico, WV, CCN 511152 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018
Lewisburg Health CenterLewisburg, WV, CCN 511158 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 2018
RMC Greenbrier Nephrology AlleghanyCovington, VA, CCN 491974 Federally qualified health center Operational/Managerial Control Jul 1, 2020
Rupert Health CenterRupert, WV, CCN 581046 Federally qualified health center Operational/Managerial Control (100%) Jun 26, 2024

Owned or controlled facilities with NPI records 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1093199036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 MEDICAL CENTER DR",
            "city": "RAINELLE",
            "state": "WV",
            "postal_code": "259621064",
            "telephone_number": "304-438-6188",
            "fax_number": "304-438-6819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 MEDICAL CENTER DRIVE",
            "city": "RAINELLE",
            "state": "WV",
            "postal_code": "259621064",
            "telephone_number": "304-438-1922",
            "fax_number": "304-438-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAINELLE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "304-438-6188"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RAINELLE MEDICAL/DENTAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rainelle, WV

Sources for this page

Verify at the official NPI Registry.