NPIMap

Organization Active NPI

Valley Health Systems Inc

Doing business as Valley Heatlh Point Pleasant Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Point Pleasant, WV
National Provider Identifier
1124323340
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY HEALTH SYSTEMS INC
Doing business as
Valley Heatlh Point Pleasant Pediatrics
Practice address
2801 Jackson Ave
Point Pleasant, WV 25550
Phone
(304) 675-4107
Fax
(304) 697-2086
NPI assigned
Jan 19, 2011
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mr. Mary-Beth Brubeck
Title
Vice President of Finance / Cfo
Phone
(304) 525-3334

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

2801 Jackson Ave
Point Pleasant, WV 25550

Mailing address

PO Box 1680
Huntington, WV 25717-1680
Phone (304) 697-1396

Other identifiers 3

IdentifierTypeStateIssuer
0072865MedicaidOH
3810021158MedicaidWV
0097852MedicaidOH

Other names 1

  • Valley Heatlh Point Pleasant Pediatrics Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110208000631 WV Part A Provider - Federally Qualified Health Center (FQHC) 9931017969 Practice locations: Point Pleasant, WV
O20120917000531 WV Part B Supplier - Public Health/Welfare Agency 9931017969 Receives reassigned benefits from 21 practitioners
1 other NPI on this enrollment
Practice locations: Point Pleasant, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124323340. Details of each certification follow.

Federally qualified health center certification: CCN 511967

Legal name
VALLEY HEALTH SYSTEMS, INC
Doing business as
VALLEY HEALTH POINT PLEASANT PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 8, 2011
Last certification
Feb 8, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1975 in WV
Enrollment address
2801 Jackson Avenue
Point Pleasant, WV 25550-1713

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Carl Johnson Medical Ce91 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sherry Perry Individual Corporate Director Jan 1, 2010
Christina Walter Individual Corporate DirectorBoard Member Apr 25, 2019
Jared Colker Individual Corporate DirectorBoard Member Dec 8, 2016
Debra Zuberbuehler Individual Corporate DirectorBoard Member Jan 1, 2025
Paulette Mabry Individual Corporate Director Dec 8, 2016
Bill Bryant Individual Corporate DirectorBoard Member Feb 28, 2011
Suzi Brodof Individual Corporate DirectorBoard Member Oct 26, 2017
Mathew Weimer Individual Corporate OfficerPresident, Ceo Sep 28, 2024
W-2 Managing Employee Sep 28, 2024
Sherrone Hornbuckle Individual Corporate DirectorBoard Member Oct 26, 2017
Mary-Beth Brubeck Individual Corporate OfficerExecutive Vice President / Cfo Jan 1, 2019
W-2 Managing EmployeeExecutive Vice President / Cfo Jan 1, 2019
Kalyn Obiozor Dorey Individual Corporate Director Nov 22, 2022
Greg Agee Individual Corporate Director Jan 1, 2010
Xavier Staggs Individual Corporate DirectorBoard Member Jan 1, 2025
Benjamin L Howard Individual Corporate Director Jan 1, 2010

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 2

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

FacilityTypeRoleSince
Valley Health Apple GroveApple Grove, WV, CCN 581056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 16, 1975
Valley Health SCP - Charleston 108Charleston, WV, CCN 581062 Federally qualified health center Operational/Managerial Control Feb 1, 2024

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1124323340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1680",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257171680",
            "telephone_number": "304-697-1396",
            "fax_number": "304-697-2086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 JACKSON AVE",
            "city": "POINT PLEASANT",
            "state": "WV",
            "postal_code": "25550",
            "telephone_number": "304-675-4107",
            "fax_number": "304-697-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "BRUBECK",
        "authorized_official_first_name": "MARY-BETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE / CFO",
        "authorized_official_telephone_number": "304-525-3334",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0072865",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810021158",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0097852",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Heatlh Point Pleasant Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Heatlh Point Pleasant Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Point Pleasant, WV

Sources for this page

Verify at the official NPI Registry.