Community Care of West Virginia, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Buckhannon, WV
NPI 1194339309 · NPPES record last updated Sep 4, 2020
Key facts
- NPI
- 1194339309
- 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
- 33 E Victoria St
Buckhannon, WV 26201-2671 - Phone
- (304) 924-6262
- Fax
- (304) 924-5460
- NPI assigned
- Sep 4, 2020
- Organization subpart
- No
Authorized official
- Name
- Dora L Potasnik
- Title
- Credentialing Coordinator
- Phone
- (304) 317-7275
Owners & managing parties with NPI records 2
-
Patricia L Collett, PA-C
Corporate family (same tax ID) 18
Practitioners 112
-
Elizabeth A Shelton, LPC
-
Joshua Scott Abbott, DDS
-
Laura Evelyn Abbott, DDS
-
Jennifer Abel, FNP-C
-
Allyson Malone Andrews, PA-C
-
Joshua Steven Baker, PAC
-
Nicholas Joel Baker, PA-C
-
Barbara Ballash, LICENSED PSYCHOLOGIS
-
Sean R. Barnett, PA-C
-
Sarah Bell, DNP
-
Paula Blount, PA
-
Tracie F Bonner, FNP
-
Cheryl Ann Bowers, PA-C
-
Brandi Carpenter, FNP-C
-
Angela Gayle Carter, APRN, BC
-
Rachel Ann Clemens, FNP
-
Patricia L Collett, PA-C
-
Liam Patrick Condon, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511190
- Legal name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Doing business as
- UPSHUR COUNTY PALS WELLNESS CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 1984 in WV
- Enrollment address
- 33 E Victoria St
Buckhannon, WV 26201-2671
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Dora L. Potasnik |
W-2 Managing Employee |
Jan 9, 2012 | |
| Kristi Walkr |
Corporate Officer |
Oct 15, 2022 | |
| Juston Chad Morrison |
Corporate Director |
Apr 10, 2017 | |
| Hillary Nicole Tenney |
W-2 Managing Employee |
Aug 1, 2019 | |
| 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 |
Sep 13, 1993 | 100% |
| David B Malcomb |
Corporate Director |
Jan 1, 2018 | |
| 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 |
Nov 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 |
|---|---|---|---|---|
| O20200921003189 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 0446232987 | Practice locations: Buckhannon, WV |
| O20210107001153 | WV | Part B Supplier - Clinic/Group Practice | 0446232987 |
Receives reassigned benefits from 2 practitioners Practice locations: Buckhannon, WV |
National Provider Directory
- Tax ID family
- Leading Creek Elem
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
33 E Victoria St
Buckhannon, WV 26201-2671
Mailing address
33 E Victoria St
Buckhannon, WV 26201-2671
Phone (304) 924-6262
Other names
- Upshur County PALS Wellness Center
Other providers in Buckhannon, WV
- Shaina M Collins
- Taylor Collins
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
All providers in Buckhannon, 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 Sep 4, 2020. 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.