Bland County Medical Clinic, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Bastian, VA
NPI 1104800671 · NPPES record last updated Sep 13, 2024
Key facts
- NPI
- 1104800671
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- BLAND COUNTY MEDICAL CLINIC, INC.
- Practice address
- 12301 Grapefield Rd
Bastian, VA 24314-4547 - Phone
- (276) 688-4331
- Fax
- (276) 688-4336
- NPI assigned
- Nov 30, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Susan Greever
- Title
- Executive Director
- Phone
- (276) 688-4331
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 25
-
Jennifer Suzanne Armstrong, FNP-BC
-
Melissa Coleman, FNP
-
Mary Jo Collie, FNP C
-
Pamela Sue Crowder, FNP-BC
-
Deborah S Croy, NP
-
Matthew Dellacona, D.O.
-
Mary A Grimmett, FNP-BC
-
Courtney Heltzel, FNP-C
-
Deana Michelle McCarty, FNP-C
-
Lynn M. Patton, FNP
-
Anna Lorie Pettrey, FNP-C
-
April Bruner Simms, LCSW
-
Angela Stroupe, NP
-
Michael O Crews, DO
-
Vincent Filanova, D.D.S.
-
Phyllis Gayle Murray, FNP-C
-
Paige Marie Akers, D.M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D0232392 | Bland County Medical Clinic, Inc | Provider-performed microscopy | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491808
- Legal name
- BLAND COUNTY MEDICAL CLINIC INC
- 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
- Corporation · Non-profit
- Enrollment address
- 12301 Grapefield
Bastian, VA 24314-4547
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia Phillippi |
Corporate Director | Sep 20, 2010 | |
| Judith a Cassell |
Corporate Director | May 1, 2019 | |
| Bobby Parsell |
Corporate Director | Sep 20, 2010 | |
| Kathy Starks |
Corporate Director | Sep 20, 2010 | |
| Susan Greever |
Corporate Officer | Jan 14, 2000 | |
| W-2 Managing Employee |
Jan 14, 2000 | 100% | |
| Rita Bradshaw |
Corporate Director | Sep 30, 2010 | |
| Denise Romano |
Corporate Director | May 1, 2020 | |
| Martha Brackeen |
Corporate Director | Sep 20, 2010 | |
| Amy Melvin |
Corporate Director |
Jul 1, 2025 | |
| W-2 Managing Employee |
Jul 1, 2025 | ||
| Linda Townley |
Corporate Director | Sep 20, 2010 | |
| Samuel Bernard |
Corporate Director | Sep 20, 2010 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Bland County Medical Clinic Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040210000077 | VA | Part B Supplier - Clinic/Group Practice | 2264326453 |
Receives reassigned benefits from 24 practitioners 1 other NPI on this enrollment Practice locations: Bastian, VA; Bland, VA |
| O20041222000559 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 2264326453 | Practice locations: Bastian, VA |
National Provider Directory
Locations
8494 S Scenic Hwy
Ste Cd
Bland, VA 24315
Phone (276) 688-0500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
12301 Grapefield Rd
Bastian, VA 24314-4547
Mailing address
12301 Grapefield Rd
Bastian, VA 24314-4547
Phone (276) 688-4331
Other practice location 1
8487 S Scenic Hwy
Bland, VA 24315-4691
Phone (276) 688-4711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007696167 | Medicaid | VA |
Other providers in Bastian, VA
- Jennifer Suzanne Armstrong
- ASC of Bastian, LLC
- Bland County Pharmacy
- Bland County Public Schools
- Monica Lynn Blankenship
- Ladonna Renae Bowling
- Stacy A Buchebner
All providers in Bastian, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.