NPIMap

Organization Active NPI

Shenandoah Valley Medical System, Inc.

Doing business as Shenandoah Community Health South Middle

  • Federally Qualified Health Center (FQHC)
  • Martinsburg, WV
National Provider Identifier
1235853144
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
Doing business as
Shenandoah Community Health South Middle
Practice address
150 Bulldog Blvd
Martinsburg, WV 25401-4221
Phone
(304) 263-4999
NPI assigned
Oct 4, 2022
Last updated
Oct 4, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SHENANDOAH VALLEY MEDICAL SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Authorized official

Name
Michael Hassing
Title
Ceo
Phone
(304) 263-4999

Specialties & licenses 1

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

Addresses

Primary practice location

150 Bulldog Blvd
Martinsburg, WV 25401-4221

Mailing address

PO Box 1146
Martinsburg, WV 25402-1146
Phone (304) 263-4999

Other names 1

  • Shenandoah Community Health South Middle Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221201000854 WV Part B Supplier - Clinic/Group Practice 9739093097 Receives reassigned benefits from 1 practitioner
Practice locations: Martinsburg, WV
O20250404002386 WV Part A Provider - Federally Qualified Health Center (FQHC) 9739093097 Practice locations: Martinsburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235853144. Details of each certification follow.

Federally qualified health center certification: CCN 581061

Legal name
SHENANDOAH VALLEY MEDICAL SYSTEM,INC.
Doing business as
SHENANDOAH COMMUNITY HEALTH SOUTH MIDDLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 17, 2022
Last certification
Nov 17, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
150 Bulldog Blvd
Martinsburg, WV 25401-4221

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Part of
Shenandoah Community Health

Locations

106 Sand Mine Rd
Ste 7
Berkeley Springs, WV 25411
Phone 30426349991063

150 Bulldog Blvd
Martinsburg, WV 25401

2004 Professional Ct
Martinsburg, WV 25401
Phone (304) 263-8964

250 East Rd
Martinsburg, WV 25404

701 S Queen St
Martinsburg, WV 25401

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Karen Hensell Individual Corporate OfficerSecretary Oct 1, 2022
Amy Olack Individual Corporate OfficerVice Chairman of the Board Oct 1, 2022
Michael Hassing Individual Corporate OfficerCeo Oct 1, 2022
W-2 Managing EmployeeCeo Oct 1, 2022
Frank S Coe Individual Corporate OfficerTreasurer Oct 1, 2022
Rudolph M Bropleh Individual Corporate OfficerChairman of the Board Oct 1, 2022

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1235853144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1146",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254021146",
            "telephone_number": "304-263-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BULLDOG BLVD",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254014221",
            "telephone_number": "304-263-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH VALLEY MEDICAL SYSTEM, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHENANDOAH VALLEY MEDICAL SYSTEM, INC.",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-09-30",
        "status": "A",
        "authorized_official_last_name": "HASSING",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-263-4999"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shenandoah Community Health South Middle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martinsburg, WV

Sources for this page

Verify at the official NPI Registry.