NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rock Cave, WV
National Provider Identifier
1194191676
Registry record updated Sep 12, 2024
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
12292 WV-20
Rock Cave, WV 26234
Phone
(304) 924-5920
Fax
(304) 924-5922
NPI assigned
Aug 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Dora L Potasnik
Title
Credentialing Coordinator
Phone
(304) 317-7275

Specialties & licenses 1

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

Addresses

Primary practice location

12292 WV-20
Rock Cave, WV 26234

Mailing address

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

Other practice location 1

1 Lizemore Street
Lizemores, WV 25125
Phone (304) 587-4823

Other identifiers 1

IdentifierTypeStateIssuer
2467-6966OtherWVWV STATE TAX DEPT

Other names 1

  • Rock Cave 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
O20151006000016 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Rock Cave, WV
O20160405000889 WV Part B Supplier - Clinic/Group Practice 0446232987 Receives reassigned benefits from 4 practitioners
Practice locations: Rock Cave, WV

Federally qualified health center certification: CCN 511079

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
ROCK CAVE ELEMENTARY SCHOOL WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2015
Last certification
Aug 24, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
12292 WV 20
Rock Cave, WV 26234

National Provider Directory

National Provider Directory
Tax ID family
Leading Creek Elem19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Ownership & related parties

All disclosed owners & managing parties 19

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
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
David B Malcomb Individual Corporate DirectorBoard Member Jan 1, 2020
Selah Raines 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
Patricia Louise Collett Individual Corporate OfficerCeo Jan 18, 2000 100%
Steven Roy Flaughers Individual Corporate DirectorBoard Member Jan 14, 2019
Shelly Gause Individual W-2 Managing EmployeeCredentialing Coordinator Jan 28, 2023
Rosemary M Thomas Individual Corporate DirectorBoard President Jan 1, 2020
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 109

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

View all 109

NPI Registry JSON

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1194191676",
    "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": "12292 WV-20",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "26234",
            "telephone_number": "304-924-5920",
            "fax_number": "304-924-5922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Lizemore Street",
            "address_purpose": "LOCATION",
            "city": "Lizemores",
            "state": "WV",
            "postal_code": "25125",
            "country_code": "US",
            "telephone_number": "304-587-4823",
            "fax_number": "304-924-5460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-19",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "304-317-7275"
    },
    "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": "WV STATE TAX DEPT",
            "identifier": "2467-6966",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock Cave Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rock Cave Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Cave, WV

Sources for this page

Verify at the official NPI Registry.