NPIMap

Organization Active NPI

Highland Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Monterey, VA
National Provider Identifier
1194784280
Registry record updated Feb 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HIGHLAND MEDICAL CENTER INC
Practice address
120 Jackson River Road
Monterey, VA 24465
Phone
(540) 468-6400
Fax
(540) 468-3301
NPI assigned
Mar 20, 2006
Last updated
Feb 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2022

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

Authorized official

Name
Janice Roberson Ellis, CPA
Title
Cfo/HR
Phone
(540) 468-6402

Specialties & licenses 1

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

Addresses

Primary practice location

120 Jackson River Road
Monterey, VA 24465

Mailing address

PO Box 490
Monterey, VA 24465-0490
Phone (540) 468-6400

Other identifiers 1

IdentifierTypeStateIssuer
007610548MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000962 VA Part A Provider - Federally Qualified Health Center (FQHC) 1759285075 Practice locations: Monterey, VA
O20040720000790 VA Part B Supplier - Clinic/Group Practice 1759285075 Receives reassigned benefits from 14 practitioners
Practice locations: Monterey, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194784280. Details of each certification follow.

Federally qualified health center certification: CCN 491858

Legal name
HIGHLAND MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 16, 2004
Last certification
Jan 16, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 2, 1993 in VA
Enrollment address
120 Jackson River Rd
Monterey, VA 24465-2416

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15976/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kristie Siron Individual Corporate OfficerBoard President Jul 1, 2021 100%
Monika Latese Eckard Individual Corporate DirectorBoard Director Aug 22, 2022
Letitia D Amirault Individual Corporate OfficerCeo Jan 6, 2020
Operational/Managerial ControlCeo Jan 6, 2020
Michael Nicholas Fatula Individual Corporate DirectorBoard Director Aug 22, 2022
Lisa Gabrielle Klein Individual Corporate OfficerBoard Treasurer Aug 22, 2022
Harmony Jean Leonard Individual Corporate OfficerBoard Secretary Aug 22, 2022
Tracey S McCray Individual Corporate DirectorBoard Director Jul 1, 2022
Janice R Ellis Individual Corporate OfficerCfo Jul 6, 2020
Gregory Nash Robinson Individual Corporate OfficerPast President Jul 1, 2022
Ronald D Wimer Individual Corporate DirectorBoard Director Aug 22, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1194784280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "MONTEREY",
            "state": "VA",
            "postal_code": "244650490",
            "telephone_number": "540-468-6400",
            "fax_number": "540-468-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 JACKSON RIVER ROAD",
            "city": "MONTEREY",
            "state": "VA",
            "postal_code": "24465",
            "telephone_number": "540-468-6400",
            "fax_number": "540-468-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "ROBERSON",
        "authorized_official_title_or_position": "CFO/HR",
        "authorized_official_telephone_number": "540-468-6402",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007610548",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monterey, VA

Sources for this page

Verify at the official NPI Registry.