NPIMap

Organization Active NPI

Community Health Association

Doing business as Jackson General Clinic

  • Clinic/Center
  • Ripley, WV
National Provider Identifier
1134417975
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
52 Issued in WV
Legal business name
COMMUNITY HEALTH ASSOCIATION
Doing business as
Jackson General Clinic
Practice address
200 Academy Drive
Ripley, WV 25271-9101
Phone
(304) 372-2731
Fax
(304) 372-2749
NPI assigned
Jul 14, 2011
Last updated
Jun 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Mrs. Stephanie L McCoy
Title
President/Ceo
Phone
(304) 373-1475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 52 WV Primary

Addresses

Primary practice location

200 Academy Drive
Ripley, WV 25271-9101

Mailing address

PO Box 720
Ripley, WV 25271-0720
Phone (304) 372-2731

Other identifiers 2

IdentifierTypeStateIssuer
1134417976OtherWVNPI
3810021320MedicaidWV

Other names 1

  • Jackson General Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000784 WV Part B Supplier - Clinic/Group Practice 1759291313 Receives reassigned benefits from 135 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ripley, WV; Ravenswood, WV

Other NPIs on the same Medicare enrollment 6

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
51D2032558Jackson General Clinic200 Academy Drive, Ripley, WV 25271Certificate of waiverNov 9, 2027

National Provider Directory

National Provider Directory

Locations

200 Academy Dr
Ripley, WV 25271
Phone (304) 372-1050

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1134417975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252710720",
            "telephone_number": "304-372-2731",
            "fax_number": "304-373-3749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ACADEMY DRIVE",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252719101",
            "telephone_number": "304-372-2731",
            "fax_number": "304-372-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-14",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "304-373-1475",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WV",
            "license": "52",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1134417976",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810021320",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson General Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ripley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.