NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

  • Federally Qualified Health Center (FQHC)
  • Clarksburg, WV
National Provider Identifier
1164809802
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Practice address
2 Mountaineer Dr
Clarksburg, WV 26301-5511
Phone
(304) 326-7620
Fax
(304) 924-5460
NPI assigned
May 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

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

Authorized official

Name
Dora L Potasnik
Title
Credentialing
Phone
(304) 587-2541

Specialties & licenses 1

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

Addresses

Primary practice location

2 Mountaineer Dr
Clarksburg, WV 26301-5511

Mailing address

PO Box 217
Rock Cave, WV 26234-0217
Phone (304) 924-6262

Other identifiers 1

IdentifierTypeStateIssuer
2306-9245OtherWVBUSINESS LICENSE

Other names 1

  • Mountaineer Elementary School Wellness Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150608001706 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Clarksburg, WV
O20150914001122 WV Part B Supplier - Clinic/Group Practice 0446232987 Receives reassigned benefits from 14 practitioners
Practice locations: Clarksburg, WV

Federally qualified health center certification: CCN 511069

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
MOUNTAINEER ELEMENTARY SCHOOL WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 11, 2015
Last certification
May 11, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
2 Mountaineer Dr
Clarksburg, WV 26301-5511

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Dora L. Potasnik Individual W-2 Managing EmployeeCredentialing Jan 9, 2012
Kristi Walkr Individual Corporate OfficerCoo Oct 15, 2022
Gina Stalnaker Individual Corporate DirectorBoard Member Feb 20, 2024
Juston Chad Morrison Individual Corporate DirectorBoard Member Jan 1, 2020
Elisabeth M Samples Individual Corporate DirectorBoard Member Jan 1, 2018
Michele Williams Individual Corporate OfficerCompliance Officer Dec 12, 2005
Jeffrey Jenkins Individual Corporate OfficerCfo Apr 4, 2022
Everett Hoffman Individual Corporate DirectorBoard Member Feb 20, 2024
David B Malcomb Individual Corporate DirectorBoard Member Jan 1, 2020
David D Taylor Individual Corporate DirectorBoard Member Mar 14, 2016
Abigail Friend Individual W-2 Managing EmployeeCredentialing Coordinator Aug 1, 2023
Katherine Anne Horner Individual Corporate DirectorBoard Vice-President Jan 14, 2019
Kimberly Renee Becher Individual Corporate OfficerChief Medical Officer Sep 23, 2021
Melanie Horn Individual W-2 Managing EmployeeCredentialing Manager Aug 26, 2024
Patricia Louise Collett Individual Corporate OfficerCeo Jan 18, 2000 100%
Shelly Gause Individual W-2 Managing EmployeeCredentialing Coordinator Jan 28, 2023
Rosemary M Thomas Individual Corporate DirectorBoard President Jan 1, 2020
Lawrence Boggs Individual Corporate DirectorBoard Member Jan 1, 2023
James L Estep Individual Corporate DirectorBoard Treasurer Jan 1, 2020
Sarina Smith Individual Corporate DirectorBoard Member Jan 14, 2019
Kevin Douglas Junkins Individual Corporate OfficerChief Behavioral Health Officer Jun 9, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
West Virginia Wesleyan College Wellness CenterBuckhannon, WV, CCN 511146 Federally qualified health center Operational/Managerial Control (100%) May 21, 2018

Practitioners & affiliated clinicians

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755561600000",
    "number": "1164809802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MOUNTAINEER DR",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263015511",
            "telephone_number": "304-326-7620",
            "fax_number": "304-924-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-01",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "2306-9245",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountaineer Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksburg, WV

Sources for this page

Verify at the official NPI Registry.