NPIMap

Organization Active NPI

Tri Area Community Health

  • Federally Qualified Health Center (FQHC)
  • Floyd, VA
National Provider Identifier
1194908491
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI AREA COMMUNITY HEALTH
Practice address
140 Christiansburg Pike NE
Floyd, VA 24091-3742
Phone
(540) 745-9290
Fax
(540) 745-9293
NPI assigned
Dec 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Authorized official

Name
Debra Shelor
Title
Executive Director
Phone
(276) 398-2854

Specialties & licenses 1

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

Addresses

Primary practice location

140 Christiansburg Pike NE
Floyd, VA 24091-3742

Mailing address

PO Box 9
Laurel Fork, VA 24352-0009
Phone (276) 398-2292

Other identifiers 1

IdentifierTypeStateIssuer
1194908491MedicaidVA

Other names 1

  • Tri Area Community Health at Floyd Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040122000969 VA Part B Supplier - Clinic/Group Practice 6204748296 Receives reassigned benefits from 46 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Independence, VA; Troutdale, VA; Stuart, VA; Laurel Fork, VA; Hillsville, VA; Galax, VA; Fries, VA; Floyd, VA…
O20071231000500 VA Part A Provider - Federally Qualified Health Center (FQHC) 6204748296 Receives reassigned benefits from 1 practitioner
Practice locations: Floyd, VA

Federally qualified health center certification: CCN 491879

Legal name
TRI AREA COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 25, 2008
Last certification
Feb 25, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 31, 1980 in VA
Enrollment address
140 Christiansburg Pike NE
Floyd, VA 24091-3742

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 9

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
49D1080023Tri-Area Community Health at Floyd140 Christiansburg Pike NE, Floyd, VA 24091Certificate of waiverJun 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Tri-Area Community Health15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Delia Heck Individual Corporate DirectorBoardmember Jan 1, 2017
Jason Wood Individual Corporate DirectorBoardmember Jan 1, 2016
Stephen Puckett Individual Corporate DirectorBoardmember Jan 1, 2017
James L Werth Individual Corporate Officer Jun 24, 2019
W-2 Managing Employee Jun 24, 2019
Nancy Puckett Individual W-2 Managing EmployeeDelegated Official Sep 18, 1991
James Houchins Individual Corporate DirectorBoardmember Jan 1, 2016
Lorene Becker Individual Corporate DirectorBoardmember Jan 1, 2018
Brenda Hopkins Individual Corporate DirectorBoardmember Jan 1, 2017
Jason Phillips Individual Corporate DirectorBoardmember Jan 1, 2018
Kayla a Boyd Individual Corporate Officer Dec 1, 2015
W-2 Managing Employee Dec 1, 2015
Chip Phillips Individual Corporate DirectorBoard Member Jan 1, 2013
Julian Webb Individual Corporate DirectorSecretary Jan 1, 2011

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Tri Area Community HealthFries, VA, CCN 491010 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 7, 2022

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1194908491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "LAUREL FORK",
            "state": "VA",
            "postal_code": "243520009",
            "telephone_number": "276-398-2292",
            "fax_number": "276-398-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 CHRISTIANSBURG PIKE NE",
            "city": "FLOYD",
            "state": "VA",
            "postal_code": "240913742",
            "telephone_number": "540-745-9290",
            "fax_number": "540-745-9293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI AREA COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "SHELOR",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "276-398-2854"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194908491",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri Area Community Health at Floyd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Floyd, VA

Sources for this page

Verify at the official NPI Registry.