Family Healthcare Associates Inc
Organization Active NPI Family Medicine Physician · Welch, WV
NPI 1134565450 · NPPES record last updated Aug 14, 2013
Key facts
- NPI
- 1134565450
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FAMILY HEALTHCARE ASSOCIATES INC
- Practice address
- 19771 Coal Heritage Rd
Welch, WV 24801 - Phone
- (304) 436-2629
- NPI assigned
- May 14, 2013
- Organization subpart
- No
Authorized official
- Name
- Stephanie Sizemore
- Title
- Insurance Billing Clerk
- Phone
- (304) 732-6735
Owners & managing parties with NPI records 4
-
Anthony R Flaim, DO
Other NPIs on the same Medicare enrollment 6
Practitioners 8
-
Joshua Tollison Bishop, PA-C
-
Connie Dale Cook II, PAC
-
Jeffrey A Prichard, PAC
-
Jackie D Shorter, PAC
-
Leah Smith, FNP
-
Rachel Leigh Stover, C-FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Rural health clinic certification: CCN 513918
- Legal name
- FAMILY HEALTHCARE ASSOCIATES INC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 28, 2013
- Last certification
- Jul 15, 2019
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Aug 11, 1986 in WV
- Enrollment address
- 19771 Coal Heritage Rd
Welch, WV 24801-9815
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Samuel Muscari |
5% Or Greater Direct Ownership Interest | Aug 11, 1986 | 25% |
| Corporate Officer | Aug 11, 1986 | ||
| Corporate Director | Aug 11, 1986 | ||
| Samuel Muscari |
5% Or Greater Direct Ownership Interest | Aug 11, 1986 | 25% |
| Corporate Officer | Aug 11, 1986 | ||
| Corporate Director | Aug 11, 1986 | ||
| Michael a Muscari |
Corporate Officer | Aug 11, 1986 | 25% |
| Corporate Director | Aug 11, 1986 | ||
| Stephanie Sizemore |
W-2 Managing Employee | Oct 17, 2001 | |
| Anthony Flaim |
5% Or Greater Direct Ownership Interest | Aug 11, 1986 | 25% |
| Corporate Officer | Aug 11, 1986 | ||
| Corporate Director | Aug 11, 1986 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000848 | WV | Part B Supplier - Clinic/Group Practice | 8325957996 |
Receives reassigned benefits from 26 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gilbert, WV; Man, WV; Mullens, WV; Oceana, WV; Pineville, WV; Welch, WV |
| O20130814000101 | WV | Part a Provider - Rural Health Clinic | 8325957996 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Welch, WV |
National Provider Directory
Locations
19771 Coal Heritage Rd
Welch, WV 24801
Phone (304) 436-2629
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
19771 Coal Heritage Rd
Welch, WV 24801
Mailing address
PO Box 1650
Pineville, WV 24874-1650
Phone (304) 732-6735
Other providers in Welch, WV
- Sharon Ranae Edgell
- Loretta Edwards
- Sandra Ann Edwards
- Machelle Rena England
- Jennifer Fain
- Family Healthcare Associates, Inc
- Jennifer Lynn Farley
- Donna Flaim
- Flat Iron Pharmacy, LLC
- Cindi Nicole Fox
All providers in Welch, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2013. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.