NPIMap

Organization Active NPI

Valley Health Systems Inc

Doing business as Valley Health Wayne High School

  • Federally Qualified Health Center (FQHC)
  • Wayne, WV
National Provider Identifier
1194790022
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY HEALTH SYSTEMS INC
Doing business as
Valley Health Wayne High School
Practice address
100 Pioneer Rd
Wayne, WV 25570
Phone
(304) 272-3783
NPI assigned
Feb 22, 2006
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mary-Beth Brubeck
Title
Vice President of Finance / Cfo
Phone
(304) 525-3334

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11577 WV
Federally Qualified Health Center (FQHC) 261QF0400X WV Primary

Addresses

Primary practice location

100 Pioneer Rd
Wayne, WV 25570

Mailing address

PO Box 1680
Huntington, WV 25717-1680

Other identifiers 1

IdentifierTypeStateIssuer
5369023000MedicaidWV

Other names 1

  • Valley Health Wayne High School Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121112000395 WV Part A Provider - Federally Qualified Health Center (FQHC) 9931017969 Practice locations: Wayne, WV
O20131009001233 WV Part B Supplier - Clinic/Group Practice 9931017969 Receives reassigned benefits from 18 practitioners
1 other NPI on this enrollment
Practice locations: Wayne, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194790022. Details of each certification follow.

Federally qualified health center certification: CCN 511006

Legal name
VALLEY HEALTH SYSTEMS, INC
Doing business as
VALLEY HEALTH WAYNE HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 13, 2012
Last certification
Nov 13, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 7, 1999 in WV
Enrollment address
100 Pioneer Rd
Wayne, WV 25570-9504

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Carl Johnson Medical Ce91 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Sherry Perry Individual Corporate DirectorBoard Member Feb 1, 1994
Christina Walter Individual Corporate DirectorBoard Member Apr 25, 2019
Jared Colker Individual Corporate DirectorBoard Member Dec 8, 2016
Paulette Mabry Individual Corporate DirectorBoard Member Dec 8, 2016
Bill Bryant Individual Corporate DirectorBoard Member Apr 28, 2011
Suzi Brodof Individual Corporate DirectorBoard Member Oct 26, 2017
Mathew Weimer Individual Corporate OfficerPresident, Ceo Sep 28, 2024
W-2 Managing Employee Sep 28, 2024
Sherrone Hornbuckle Individual Corporate DirectorBoard Member Oct 26, 2017
Mary-Beth Brubeck Individual Corporate OfficerCfo Jan 1, 2019
Corporate DirectorCfo Jan 1, 2019
W-2 Managing EmployeeCfo Jan 1, 2019
Kalyn Obiozor Dorey Individual Corporate Director Nov 22, 2022
Greg Agee Individual Corporate DirectorBoard Member Jan 27, 2005
Jill Hutchinson Individual Corporate DirectorBoard Member Jan 27, 2005
Benjamin L Howard Individual Corporate DirectorBoard Member Jan 1, 2003

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Valley Health Apple GroveApple Grove, WV, CCN 581056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 16, 1975
Valley Health SCP - Charleston 108Charleston, WV, CCN 581062 Federally qualified health center Operational/Managerial Control Feb 1, 2024

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1194790022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1680",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257171680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PIONEER RD",
            "city": "WAYNE",
            "state": "WV",
            "postal_code": "25570",
            "telephone_number": "304-272-3783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "BRUBECK",
        "authorized_official_first_name": "MARY-BETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE / CFO",
        "authorized_official_telephone_number": "304-525-3334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "11577",
            "primary": false
        },
        {
            "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": "5369023000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health Wayne High School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health Wayne High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wayne, WV

Sources for this page

Verify at the official NPI Registry.