Wirt County Health Services Association, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Ripley, WV
NPI 1265615728 · NPPES record last updated Jan 3, 2014
Key facts
- NPI
- 1265615728
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
- Practice address
- 4A School St
Ripley, WV 25271-1538 - Phone
- (304) 372-7341
- Fax
- (304) 372-7341
- NPI assigned
- Dec 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Vicki L. Knicely
- Title
- Billing/Credentialing Supervisor
- Phone
- (304) 275-3301
Owners & managing parties with NPI records 1
-
David M Schenkelberg, MA,, LPCC
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 10
Related certifications (CCN) 1
Practitioners 37
-
Lauren Marie Alexander, PA-C
-
Ashley M Blanc, MA
-
Miranda Sue Boso, C-FNP
-
Richard Edward Cain, M.D.
-
Sarah L. Casseday, LPC
-
Erica Elaine Conant, FNP
-
Nancy Rose Creighton, LPC, ALPS
-
Elizabeth Cruger, LPC
-
Rachael Yoder Jarvis, LICSW
-
Heather J Kay, CFNP
-
Lindsey A. Keeney, PA-C
-
Shirin M Morad, DO
-
Cami Myers, FNP-C
-
Darrin Earl Nichols, M.D.
-
Mary Frances Treadway, FNP-BC
-
Kenna Lea Wagner, MSN, APRN, FNP-BC
-
Richard W Watson, M.D.
-
Leann McKay Williams, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WV
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
- Corporation · Non-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
- Corporation · Non-profit
- Incorporated
- Jul 17, 1978 in WV
- Enrollment address
- 562 Charleston Dr
Ripley, WV 25271-1533
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Donald Brookover |
Corporate Director | Feb 7, 2003 | |
| Treva Full |
Corporate Director |
Feb 1, 2010 | |
| Julie a Stanley |
Corporate Officer |
Jan 1, 2018 | |
| Berkley Simmons |
Corporate Director |
Dec 1, 2014 | |
| James Frazier |
Other |
Aug 1, 2011 | |
| Melissa Weekley |
Corporate Director |
Jul 1, 2013 | |
| David M Schenkelberg |
Corporate Director |
Aug 1, 2013 | |
| Judy Cline |
Corporate Director | Feb 7, 2003 | |
| Vicki Knicely |
W-2 Managing Employee |
Mar 1, 2002 | |
| Corporate Officer | Jul 1, 2014 | ||
| W-2 Managing Employee | Aug 1, 2005 | ||
| Douglas Full |
Corporate Director |
Jul 1, 2013 | |
| Anessa Dille |
W-2 Managing Employee |
Jul 1, 2014 | |
| Rob Dudley |
Corporate Officer |
Sep 8, 2018 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Ripley Family Medicine |
Federally qualified health center | Operational/Managerial Control | Jul 17, 1978 |
| Wirt County Health Services Association, Inc |
Federally qualified health center | Operational/Managerial Control | Oct 13, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
4A School St
Ripley, WV 25271
Phone (304) 372-7341
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009486002 | Medicaid | WV |
Other names
- Jackson County School Wellness Center
Other providers in Ripley, WV
- Leann McKay Williams
- Matthew Williams
- Robert J Williamson
- Charlene Wilson
- Wirt County Health Services Association Inc
- Wirt County Health SVC Assoc Inc
- Evelyn Jolie Withrow
- Monica Withrow
- Ashley Wolfe
- Miranda Wolfe
All providers in Ripley, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.