Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

Roanoke Elementary School Wellness Center

Practice address

1176 Oil Creek Rd
Roanoke, WV 26447-8263

Phone

(304) 452-0001

Fax

(304) 452-0002

NPI assigned

Aug 13, 2015

Last updated

Aug 25, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dora L Potasnik

Title

Credentialing

Phone

(304) 587-2541

Specialties & licenses 1

Addresses

Other names 1

• Roanoke Elementary School Wellness Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104292168. Details of each certification follow.

• CCN 511084 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 511084

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

ROANOKE ELEMENTARY SCHOOL WELLNESS CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 1, 2015

Last certification

Sep 1, 2015

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 1984 in WV

Enrollment address

1176 Oil Creek Rd
Roanoke, WV 26447-8263

Locations

All disclosed owners & managing parties 22

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

Owners & managing parties with NPI records 3

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

• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863

  Corporate Officer

  CMS ownership
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760

  Corporate Officer

  CMS ownership
• Kevin Douglas Junkins, MD

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1629344858

  Corporate Officer

  CMS ownership

All facility ownership & control disclosures 1

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

Practitioners 101

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.

• Joshua Scott Abbott, DDS

  • Dentist
  • Green Bank, WV
  • NPI 1891041406
  Medicare reassignment NPD
• Laura Evelyn Abbott, DDS

  • Dentist
  • Green Bank, WV
  • NPI 1093061608
  Medicare reassignment NPD
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760
  Medicare reassignment NPD
• Melissa S Dodrill, M.D.

  • Family Medicine Physician
  • West Milford, WV
  • NPI 1871887349
  Medicare reassignment NPD
• Genevieve F Larimer Dunn, FNP-BC

  • Family Nurse Practitioner
  • Buckhannon, WV
  • NPI 1861708513
  Medicare reassignment NPD
• Raymond Leonard, MD

  • Pediatrics Physician
  • Rock Cave, WV
  • NPI 1376769984
  Medicare reassignment NPD
• Heather Anne Radcliffe, LICSW ACSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1649539396
  Medicare reassignment NPD
• Kristen Alanna Reed, FNP-C

  • Family Nurse Practitioner
  • Buckhannon, WV
  • NPI 1861237125
  Medicare reassignment NPD
• Yvonne Marie Staschiak Chapman, FNP

  • Family Nurse Practitioner
  • Buckhannon, WV
  • NPI 1932625597
  Medicare reassignment NPD
• Jaclyn K Swick, PA-C

  • Physician Assistant
  • Weston, WV
  • NPI 1023332699
  Medicare reassignment NPD
• Iris Mae Canete Trinidad-Carillo, M.D

  • Family Medicine Physician
  • Rock Cave, WV
  • NPI 1386873024
  Medicare reassignment NPD
• Aimee M Whitehair, MD

  • Family Medicine Physician
  • Rock Cave, WV
  • NPI 1003093097
  Medicare reassignment NPD

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

{
    "created_epoch": "1439424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1104292168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 OIL CREEK RD",
            "city": "ROANOKE",
            "state": "WV",
            "postal_code": "264478263",
            "telephone_number": "304-452-0001",
            "fax_number": "304-452-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-13",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roanoke Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teresa Magdalina Chandler
• Dessie Groves
• Kaylyn Hall, RN
• Kaitlin Taylor Pitts
• Barbara Posey
• Megan Ashley Sattelmaier

• Federally Qualified Health Center (FQHC) in Roanoke, WV
• Providers in Roanoke, WV by specialty
• Federally Qualified Health Center (FQHC) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.