NPIMap

Organization Active NPI

Rockbridge Area Free Clinic

Doing business as RAHC- Buena Vista

  • Federally Qualified Health Center (FQHC)
  • Buena Vista, VA
National Provider Identifier
1265175608
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROCKBRIDGE AREA FREE CLINIC
Doing business as
RAHC- Buena Vista
Practice address
2127 Magnolia Ave
Buena Vista, VA 24416-3111
Phone
(540) 464-8700
NPI assigned
Apr 14, 2022
Last updated
Apr 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Authorized official

Name
Valerie Suzanne Sheridan
Title
Ceo
Phone
(540) 464-8700

Specialties & licenses 1

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

Addresses

Primary practice location

2127 Magnolia Ave
Buena Vista, VA 24416-3111

Mailing address

25 Northridge LN
Lexington, VA 24450-3399
Phone (540) 464-8700

Other names 1

  • RAHC- Buena Vista Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL eCW Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230222002330 VA Part A Provider - Federally Qualified Health Center (FQHC) 2860626231 Practice locations: Buena Vista, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265175608. Details of each certification follow.

Federally qualified health center certification: CCN 491007

Legal name
ROCKBRIDGE AREA FREE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 22, 2023
Last certification
Feb 22, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 18, 1992 in VA
Enrollment address
2127 Magnolia Ave
Buena Vista, VA 24416-3111

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Rockbridge Area Free Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

2127 Magnolia Ave
Buena Vista, VA 24416
Phone (540) 464-8700

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
Patricia Jones Individual Corporate Officer May 1, 2017
Jane T Horton Individual Corporate Officer May 1, 2015
David a Dugan Individual Corporate Officer May 1, 2020
Valerie Suzanne Sheridan Individual W-2 Managing Employee Feb 20, 2014
Operational/Managerial ControlCeo Feb 20, 2014 100%
Dennis Cropper Individual Corporate Officer May 1, 2019

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1265175608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 NORTHRIDGE LN",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244503399",
            "telephone_number": "540-464-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2127 MAGNOLIA AVE",
            "city": "BUENA VISTA",
            "state": "VA",
            "postal_code": "244163111",
            "telephone_number": "540-464-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKBRIDGE AREA FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-14",
        "last_updated": "2022-04-14",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "SHERIDAN",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "540-464-8700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "eCW",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDMA",
            "address_1": "2127 Magnolia Ave",
            "city": "Buena Vista",
            "state": "VA",
            "country_code": "US",
            "postal_code": "244163111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "RAHC- Buena Vista",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buena Vista, VA

Sources for this page

Verify at the official NPI Registry.