NPIMap

Organization Active NPI

Valley Professionals Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Clinton, IN
National Provider Identifier
1104006253
Registry record updated Feb 19, 2015
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
777 S Main St
Suite 100
Clinton, IN 47842-2493
Phone
(765) 828-1003
Fax
(765) 828-1030
NPI assigned
Nov 6, 2007
Last updated
Feb 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2015

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

Authorized official

Name
Terry J. Warren
Title
Ceo
Phone
(812) 828-1003

Specialties & licenses 1

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

Addresses

Primary practice location

777 S Main St
Suite 100
Clinton, IN 47842-2493

Mailing address

PO Box 344
Clinton, IN 47842-0344
Phone (765) 828-1003

Other identifiers 1

IdentifierTypeStateIssuer
200884580AMedicaidIN

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
Practice locations: West Terre Haute, IN; Terre Haute, IN; Rockville, IN; Clinton, IN; Crawfordsville, IN; Bloomingdale, IN; Cayuga, IN
O20080204000562 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618067265 Practice locations: Clinton, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104006253. Details of each certification follow.

Federally qualified health center certification: CCN 151849

Legal name
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2008
Last certification
Apr 4, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 9, 2007 in IN
Enrollment address
777 S Main St
Ste 100
Clinton, IN 47842-2493

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
15D1079674Valley Professional Community Health Center777 S Main St Suite 100, Clinton, IN 47842Provider-performed microscopyFeb 4, 2028

National Provider Directory

National Provider Directory

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 DirectorBoard Secretary Feb 1, 2020
Loretta Johnson Individual Corporate DirectorBoard Member Feb 1, 2020
Jacqueline Mathis Individual Corporate Director Jan 1, 2024
David Allen Chapman Individual Corporate Director Jan 1, 2023
Terry J Warren Individual Corporate OfficerCeo Dec 20, 2016
W-2 Managing EmployeeCeo Sep 22, 2008
Michael Miller Individual Corporate Director Jan 1, 2024
Kristin Craig Individual Corporate DirectorBoard Member Feb 1, 2020
Mark Russell Individual Corporate Director Jan 1, 2022
Ronald Hodge Individual Corporate Officer 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 OfficerChief Medical Officer Sep 1, 2022
W-2 Managing EmployeeDO Sep 1, 2022
Louis Bonomo Individual Corporate Officer Mar 7, 2025
Jessica Marie Purcell Individual Corporate Director Jan 1, 2023
Jill Pastore Individual Corporate DirectorBoard Member Feb 1, 2020
Christopher M Williams Individual Corporate Director Jan 1, 2023

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 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1104006253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "CLINTON",
            "state": "IN",
            "postal_code": "478420344",
            "telephone_number": "765-828-1003",
            "fax_number": "765-828-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 S MAIN ST",
            "address_2": "SUITE 100",
            "city": "CLINTON",
            "state": "IN",
            "postal_code": "478422493",
            "telephone_number": "765-828-1003",
            "fax_number": "765-828-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-828-1003"
    },
    "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": "200884580A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, IN

Sources for this page

Verify at the official NPI Registry.