NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

Doing business as Davis & Elkins College Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Elkins, WV
National Provider Identifier
1235877267
Registry record updated May 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
Davis & Elkins College Wellness Center
Practice address
70 Graceland Drive
Elkins, WV 26241
Phone
(304) 473-5600
NPI assigned
May 20, 2022
Last updated
May 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2022

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

Authorized official

Name
Hillary Tenney
Title
Credentialing Coortinator
Phone
(304) 317-7425

Specialties & licenses 1

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

Addresses

Primary practice location

70 Graceland Drive
Elkins, WV 26241

Mailing address

70 Graceland Drive
Elkins, WV 26241

Other identifiers 1

IdentifierTypeStateIssuer
2427-1445OtherWVBUSINESS LICENSE

Other names 1

  • Davis & Elkins College Wellness Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220615003313 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Elkins, WV
O20221123001335 WV Part B Supplier - Clinic/Group Practice 0446232987 Receives reassigned benefits from 13 practitioners
Practice locations: Elkins, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235877267. Details of each certification follow.

Federally qualified health center certification: CCN 581827

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
DAVIS AND ELKINS COLLEGE WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 28, 2022
Last certification
Apr 28, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
70 Graceland Dr
Elkins, WV 26241

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Dora L. Potasnik Individual W-2 Managing EmployeeCredentialing Coordinator Jan 9, 2012
Kristi Walkr Individual Corporate OfficerCoo Oct 15, 2022
Juston Chad Morrison Individual Corporate Director Apr 10, 2017
Elisabeth M Samples Individual Corporate DirectorBoard Secretary Jan 1, 2018
Michele Williams Individual Corporate OfficerCompliance Officer Dec 12, 2005
Jeffrey Jenkins Individual Corporate OfficerCfo Apr 4, 2022
Richard G Simon Individual Corporate OfficerCeo Sep 13, 1993
David B Malcomb Individual Corporate Director Jan 1, 2018
Selah Raines Individual Corporate Director Jan 1, 2020
David D Taylor Individual Corporate Director Mar 14, 2016
Katherine Anne Horner Individual Corporate DirectorBoard Vice- President Jan 14, 2019
Kimberly Renee Becher Individual Corporate OfficerChief Medical Officer Sep 23, 2021
Patricia Louise Collett Individual Corporate OfficerDeputy Ceo Nov 18, 2000
Steven Roy Flaughers Individual Corporate Director Jan 14, 2019
Rosemary M Thomas Individual Corporate DirectorBoard President Jan 1, 2020
James L Estep Individual Corporate DirectorBoard Treasurer Jan 1, 2020
Sarina Smith Individual Corporate Director Jan 14, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
West Virginia Wesleyan College Wellness CenterBuckhannon, WV, CCN 511146 Federally qualified health center Operational/Managerial Control (100%) May 21, 2018

Practitioners & affiliated clinicians

Practitioners 100

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 100

NPI Registry JSON

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1235877267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 GRACELAND DRIVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "26241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 GRACELAND DRIVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "26241",
            "telephone_number": "304-473-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "TENNEY",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORTINATOR",
        "authorized_official_telephone_number": "304-317-7425"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "2427-1445",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis & Elkins College Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkins, WV

Sources for this page

Verify at the official NPI Registry.