NPIMap

Organization Active NPI

Wirt County Health Services Association, Inc

Doing business as Jackson County School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Ripley, WV
National Provider Identifier
1265615728
Registry record updated Jan 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
Jackson County School Wellness Center
Practice address
4A School St
Ripley, WV 25271-1538
Phone
(304) 372-7341
Fax
(304) 372-7341
NPI assigned
Dec 7, 2007
Last updated
Jan 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2014

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

Authorized official

Name
Vicki L. Knicely
Title
Billing/Credentialing Supervisor
Phone
(304) 275-3301

Specialties & licenses 2

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

Addresses

Primary practice location

4A School St
Ripley, WV 25271-1538

Mailing address

PO Box 609
Elizabeth, WV 26143-0609
Phone (304) 275-3301

Other identifiers 1

IdentifierTypeStateIssuer
0009486002MedicaidWV

Other names 1

  • Jackson County School Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030207000014 WV Part A Provider - Federally Qualified Health Center (FQHC) 7810806577 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ravenswood, WV
O20140606000978 WV Part A Provider - Federally Qualified Health Center (FQHC) 7810806577 Practice locations: Ripley, WV
O20140729001132 WV Part B Supplier - Clinic/Group Practice 7810806577 Receives reassigned benefits from 32 practitioners
Practice locations: Ripley, WV

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1265615728. Details of each certification follow.

Federally qualified health center certification: CCN 511886

Legal name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
RIVER VALLEY FAMILY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 23, 2003
Last certification
Jan 23, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 1978 in WV
Enrollment address
606 Washington St
Ravenswood, WV 26164-1730
Related CCNs
511863

Federally qualified health center certification: CCN 511048

Legal name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
JACKSON COUNTY SCHOOLS WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 4, 2014
Last certification
May 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 1978 in WV
Enrollment address
562 Charleston Dr
Ripley, WV 25271-1533

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

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

Locations

4A School St
Ripley, WV 25271
Phone (304) 372-7341

562 Charleston Dr
Ripley, WV 25271
Phone (304) 372-7341

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
Donald Brookover Individual Corporate Director Feb 7, 2003
Treva Full Individual Corporate DirectorBoard Member Feb 1, 2010
Julie a Stanley Individual Corporate OfficerCfo Jan 1, 2018
Berkley Simmons Individual Corporate DirectorBoard Member Dec 1, 2014
James Frazier Individual OtherBoard Member Aug 1, 2011
Melissa Weekley Individual Corporate DirectorBoard Member Jul 1, 2013
David M Schenkelberg Individual Corporate DirectorBoard Member Aug 1, 2013
Judy Cline Individual Corporate Director Feb 7, 2003
Vicki Knicely Individual W-2 Managing EmployeeOffice Manager Mar 1, 2002
Corporate Officer Jul 1, 2014
W-2 Managing Employee Aug 1, 2005
Douglas Full Individual Corporate DirectorBoard Member Jul 1, 2013
Anessa Dille Individual W-2 Managing EmployeeCredentialing Supervisor Jul 1, 2014
Rob Dudley Individual Corporate OfficerCeo Sep 8, 2018

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
Ripley Family MedicineRipley, WV, CCN 511933 Federally qualified health center Operational/Managerial Control Jul 17, 1978
Wirt County Health Services Association, IncParkersburg, WV, CCN 581818 Federally qualified health center Operational/Managerial Control Oct 13, 2021

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388707200000",
    "number": "1265615728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "ELIZABETH",
            "state": "WV",
            "postal_code": "261430609",
            "telephone_number": "304-275-3301",
            "fax_number": "304-275-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4A SCHOOL ST",
            "city": "RIPLEY",
            "state": "WV",
            "postal_code": "252711538",
            "telephone_number": "304-372-7341",
            "fax_number": "304-372-7341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2014-01-03",
        "status": "A",
        "authorized_official_last_name": "KNICELY",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "304-275-3301"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009486002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson County School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ripley, WV

Sources for this page

Verify at the official NPI Registry.