NPIMap

Organization Active NPI

Bland County Medical Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bastian, VA
National Provider Identifier
1104800671
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Sep 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Authorized official

Name
Ms. Susan Greever
Title
Executive Director
Phone
(276) 688-4331

Specialties & licenses 1

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104800671. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
12301 Grapefield
Bastian, VA 24314-4547

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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
49D0232392Bland County Medical Clinic, Inc12301 Grapefield Road, Bastian, VA 24314Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Patricia Phillippi Individual Corporate Director Sep 20, 2010
Judith a Cassell Individual Corporate Director May 1, 2019
Bobby Parsell Individual Corporate Director Sep 20, 2010
Kathy Starks Individual Corporate Director Sep 20, 2010
Susan Greever Individual Corporate Officer Jan 14, 2000
W-2 Managing EmployeeCeo Jan 14, 2000 100%
Rita Bradshaw Individual Corporate Director Sep 30, 2010
Denise Romano Individual Corporate Director May 1, 2020
Martha Brackeen Individual Corporate Director Sep 20, 2010
Amy Melvin Individual Corporate DirectorAuthorized Official/Ceo Jul 1, 2025
W-2 Managing EmployeeAuthorized Official/Ceo Jul 1, 2025
Linda Townley Individual Corporate Director Sep 20, 2010
Samuel Bernard Individual Corporate Director Sep 20, 2010

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Bland County Medical Clinic IncBland, VA, CCN 491001 Federally qualified health center Operational/Managerial Control (100%) Feb 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1104800671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 GRAPEFIELD RD",
            "city": "BASTIAN",
            "state": "VA",
            "postal_code": "243144547",
            "telephone_number": "276-688-4331",
            "fax_number": "276-688-4336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 GRAPEFIELD RD",
            "city": "BASTIAN",
            "state": "VA",
            "postal_code": "243144547",
            "telephone_number": "276-688-4331",
            "fax_number": "276-688-4336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8487 S Scenic Hwy",
            "address_purpose": "LOCATION",
            "city": "Bland",
            "state": "VA",
            "postal_code": "243154691",
            "country_code": "US",
            "telephone_number": "276-688-4711",
            "fax_number": "276-688-4712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLAND COUNTY MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-30",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "GREEVER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "276-688-4331",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastian, VA

Sources for this page

Verify at the official NPI Registry.