Community Care of West Virginia, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Green Bank, WV
NPI 1164557237 · NPPES record last updated Jan 25, 2012
Key facts
- NPI
- 1164557237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Practice address
- 90 Route 28
Green Bank, WV 24944-0085 - Phone
- (304) 456-5115
- Fax
- (304) 456-5117
- NPI assigned
- Feb 22, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
- Name
- Connie Simmons
- Title
- Coo Cfo
- Phone
- (304) 924-6262
Owners & managing parties with NPI records 2
-
Patricia L Collett, PA-C
Other NPIs on the same Medicare enrollment 14
Practitioners 104
-
Joshua Scott Abbott, DDS
-
Laura Evelyn Abbott, DDS
-
Allyson Malone Andrews, PA-C
-
Joshua Steven Baker, PAC
-
Nicholas Joel Baker, PA-C
-
Barbara Ballash, LICENSED PSYCHOLOGIS
-
Sarah Bell, DNP
-
Paula Blount, PA
-
Tracie F Bonner, FNP
-
Brandi Carpenter, FNP-C
-
Angela Gayle Carter, APRN, BC
-
Rachel Ann Clemens, FNP
-
Patricia L Collett, PA-C
-
Betsy Coulter, LICSW
-
Penny N Cutlip, FNP
-
Melany W Davis, LICSW
-
Victoria M Dobbins, FNP
-
Melissa S Dodrill, M.D.
-
Joan Maria Doris, D.S.W., L.I.C.S.W.
-
Matya Drennen, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511931
- Legal name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Doing business as
- COMMUNITY CARE OF GREEN BANK
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 24, 2007
- Last certification
- Oct 24, 2007
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 1984 in WV
- Enrollment address
- 4498 Potomac Highlands TRL
Green Bank, WV 24944
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Dora L. Potasnik |
W-2 Managing Employee |
Sep 26, 2011 | |
| Kristi Walkr |
Corporate Officer |
Oct 15, 2022 | |
| Juston Chad Morrison |
Corporate Director |
Jan 1, 2020 | |
| Hillary Nicole Tenney |
W-2 Managing Employee |
Aug 1, 2018 | |
| Elisabeth M Samples |
Corporate Director |
Jan 1, 2018 | |
| Michele Williams |
Corporate Officer |
Dec 12, 2005 | |
| Jeffrey Jenkins |
Corporate Officer |
Apr 4, 2022 | |
| Richard G Simon |
Corporate Officer |
Jul 1, 2007 | 100% |
| David B Malcomb |
Corporate Director |
Jan 1, 2020 | |
| Selah Raines |
Corporate Director |
Jan 1, 2020 | |
| David D Taylor |
Corporate Director |
Mar 14, 2016 | |
| Katherine Anne Horner |
Corporate Director |
Jan 14, 2019 | |
| Kimberly Renee Becher |
Corporate Officer |
Sep 23, 2021 | |
| Patricia Louise Collett |
Corporate Officer |
Jan 18, 2000 | |
| Steven Roy Flaughers |
Corporate Director |
Jan 14, 2019 | |
| Rosemary M Thomas |
Corporate Director |
Jan 1, 2020 | |
| James L Estep |
Corporate Director |
Jan 1, 2020 | |
| Sarina Smith |
Corporate Director |
Jan 14, 2019 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| West Virginia Wesleyan College Wellness Center |
Federally qualified health center | Operational/Managerial Control (100%) | May 21, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071018000710 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 0446232987 | Practice locations: Green Bank, WV |
| O20071024000166 | WV | Part B Supplier - Public Health/Welfare Agency | 0446232987 |
Receives reassigned benefits from 74 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clay, WV; Buckhannon, WV; West Milford, WV; Rock Cave, WV; Marlinton, WV; Ivydale, WV; Helvetia, WV; Green Bank, WV… |
National Provider Directory
- Part of
- Leading Creek Elem
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | WV | Yes |
Addresses
Primary practice location
90 Route 28
Green Bank, WV 24944-0085
Mailing address
PO Box 217
Rock Cave, WV 26234
Phone (304) 924-6262
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810010087 | Medicaid | WV |
Other names
- Community Care of Green Bank
Other providers in Green Bank, WV
- Joshua Scott Abbott
- Laura Evelyn Abbott
- Nancy Sue Arbogast
- Jennifer L. Chestnut
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Cornerstone Medical Group of West Virginia LLC
- Megan Curry
All providers in Green Bank, WV · Federally Qualified Health Center (FQHC) 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 Jan 25, 2012. 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.