NPIMap

Organization Active NPI

Monroe County Health Center, Board of Trustees

  • Federally Qualified Health Center (FQHC)
  • Peterstown, WV
National Provider Identifier
1174725188
Registry record updated Nov 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MONROE COUNTY HEALTH CENTER, BOARD OF TRUSTEES
Practice address
2869 Seneca Trail
Peterstown, WV 24963
Phone
(304) 753-4336
Fax
(304) 753-4097
NPI assigned
Jun 1, 2007
Last updated
Nov 23, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
MONROE COUNTY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 23, 2015

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

Authorized official

Name
Mr. James M Nelson
Title
Ceo
Phone
(304) 772-3064

Specialties & licenses 1

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

Addresses

Primary practice location

2869 Seneca Trail
Peterstown, WV 24963

Mailing address

200 Health Center Drive
PO Box 590
Union, WV 24983
Phone (304) 772-3064

Other identifiers 4

IdentifierTypeStateIssuer
3810011420MedicaidWV
DB2513OtherWVMEDICARE RR GROUP
001706775OtherWVBC/BS
5611053OtherWVAETNA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030221000010 WV Part A Provider - Federally Qualified Health Center (FQHC) 3173432671 Practice locations: Peterstown, WV
O20040330001675 WV Part B Supplier - Public Health/Welfare Agency 3173432671 Receives reassigned benefits from 29 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Union, WV; Peterstown, WV; Lindside, WV; Forest Hill, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174725188. Details of each certification follow.

Federally qualified health center certification: CCN 511887

Legal name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Doing business as
MONROE HEALTH CENTER-PETERSTOWN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 13, 2003
Last certification
Mar 13, 2003
Ownership / control type
Non-profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 1, 2003 in WV
Enrollment address
2869 Seneca TRL S
Peterstown, WV 24963-5037
Related CCNs
511837

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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
51D1008586Monroe Health Center - Peterstown2869 Seneca TRL S, Peterstown, WV 24963Provider-performed microscopyAug 31, 2027

National Provider Directory

National Provider Directory
Part of
Monroe County Health Center Board of Trustees

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71937

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Joann Galford Individual W-2 Managing Employee Jan 1, 2010
Rebekah Stone Individual Corporate OfficerChief Executive Officer Nov 27, 1995
Sheila Johnson Individual Corporate Officer Jan 1, 2015
Cathi F Biggs Individual Corporate DirectorBoard Member Sep 26, 2013
Wayne D Spangler Individual Corporate DirectorBoard Member Dec 30, 2007
Shirley H Dixon Individual Corporate DirectorBoard Member Feb 21, 2013
Jeff Jones Individual Corporate Officer Jan 1, 2016
Walter Marsden Individual Corporate DirectorBoard Member Sep 26, 2013
Janet W Caulkins Individual Corporate DirectorBoard Member Feb 21, 2003
Shelby Jennings Individual Corporate DirectorBoard Member Sep 26, 2013
Michelle Ballard Individual W-2 Managing Employee Dec 30, 2007
Jeffry a Pritt Individual Corporate DirectorBoard Member Dec 30, 2007
Todd Sutton Individual Corporate Officer Jan 1, 2016
Debbie D Snead Individual Corporate DirectorBoard Member Dec 30, 2007
Melissa F Boggs Individual Corporate DirectorBoard Member Dec 30, 2007

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Craig County Health CenterNew Castle, VA, CCN 491881 Federally qualified health center Operational/Managerial Control (100%) Aug 30, 2007
Monroe Health CenterUnion, WV, CCN 511837 Federally qualified health center Operational/Managerial Control (100%) Jun 30, 2006

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448236800000",
    "number": "1174725188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HEALTH CENTER DRIVE",
            "address_2": "PO BOX 590",
            "city": "UNION",
            "state": "WV",
            "postal_code": "24983",
            "telephone_number": "304-772-3064",
            "fax_number": "304-772-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2869 SENECA TRAIL",
            "city": "PETERSTOWN",
            "state": "WV",
            "postal_code": "24963",
            "telephone_number": "304-753-4336",
            "fax_number": "304-753-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE COUNTY HEALTH CENTER, BOARD OF TRUSTEES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONROE COUNTY HEALTH CENTER",
        "enumeration_date": "2007-06-01",
        "last_updated": "2015-11-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-772-3064",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011420",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP",
            "identifier": "DB2513",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "001706775",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5611053",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peterstown, WV

Sources for this page

Verify at the official NPI Registry.