NPIMap

Organization Active NPI

Rainelle Medical Center Inc

Doing business as Meadow Bridge Clinic

  • Federally Qualified Health Center (FQHC)
  • Meadow Bridge, WV
National Provider Identifier
1093883324
Registry record updated Nov 16, 2023
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
Doing business as
Meadow Bridge Clinic
Practice address
8971 Sewell Creek Road
Meadow Bridge, WV 25976
Phone
(304) 484-7755
Fax
(304) 484-6205
NPI assigned
Dec 4, 2006
Last updated
Nov 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

8971 Sewell Creek Road
Meadow Bridge, WV 25976

Mailing address

1502 Meadow Bridge Rd
Meadow Bridge, WV 25976-9655
Phone (304) 484-7755

Other identifiers 1

IdentifierTypeStateIssuer
0035241003MedicaidWV

Other names 1

  • Meadow Bridge Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000112 WV Part B Supplier - Public Health/Welfare Agency 7416861810 Receives reassigned benefits from 73 practitioners
3 other NPIs on this enrollment
Practice locations: Alderson, WV; Meadow Bridge, WV; Rainelle, WV
O20040331001318 WV Part A Provider - Federally Qualified Health Center (FQHC) 7416861810 Practice locations: Meadow Bridge, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093883324. Details of each certification follow.

Federally qualified health center certification: CCN 511883

Legal name
RAINELLE MEDICAL CENTER INC
Doing business as
MEADOW BRIDGE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 6, 2001
Last certification
Mar 6, 2001
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 13, 1988 in WV
Enrollment address
8971 Sewell Creek Rd
Meadow Bridge, WV 25976-0120
Related CCNs
511817

Facilities connected through Provider of Services related, parent or unit certification numbers.

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

Other NPIs on the same Medicare enrollment 2

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
51D0665221Meadow Bridge Clinic8971 Sewell Creek Road, Meadow Bridge, WV 25976Certificate of waiverMay 9, 2027

National Provider Directory

National Provider Directory

Locations

101 Railroad St
Alderson, WV 24910
Phone (304) 438-6818

176 Medical Center Dr
Rainelle, WV 25962

Ownership & related parties

All disclosed owners & managing parties 15

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 DirectorBod Jan 1, 2006
Stephen Baldwin Individual Corporate OfficerBoard Member Jan 1, 2022
Kristi Atha-Rader Individual Corporate Director Sep 8, 2010
W-2 Managing Employee Mar 19, 2013
Gary G Veronneau Individual Corporate Director Sep 8, 2010
Elizabeth Campbell Individual Corporate DirectorBoard Member Jan 1, 2022
Kimberly Howard Individual Corporate DirectorBod Jan 1, 2006
Ron Fleshman Individual Corporate Director Sep 8, 2010
Barry Crist Individual Corporate Officer Jan 1, 2022
Debra J Bennett Individual Corporate DirectorDirector of Credentialing Jan 2, 1999
Nina Blankenship Individual Corporate OfficerBoard Member Jan 1, 2022
Christopher Clay Individual Corporate Director Dec 15, 2008
Henry Bivens Individual Corporate DirectorBoard Member Jan 1, 2022
Jessie Boone Individual Corporate OfficerBoard Member Jan 1, 2019
Frank Mullins Individual Corporate Director Sep 8, 2010
George Hall Individual Corporate DirectorBod Jan 1, 2006

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 73

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 73

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1093883324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 MEADOW BRIDGE RD",
            "city": "MEADOW BRIDGE",
            "state": "WV",
            "postal_code": "259769655",
            "telephone_number": "304-484-7755",
            "fax_number": "304-484-6205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8971 SEWELL CREEK ROAD",
            "city": "MEADOW BRIDGE",
            "state": "WV",
            "postal_code": "25976",
            "telephone_number": "304-484-7755",
            "fax_number": "304-484-6205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAINELLE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-14",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035241003",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadow Bridge Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meadow Bridge Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meadow Bridge, WV

Sources for this page

Verify at the official NPI Registry.