NPIMap

Organization Active NPI

Pendleton Community Care, Inc.

  • Clinical Medical Laboratory
  • Franklin, WV
National Provider Identifier
1265634059
Registry record updated Jul 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
51D0872802 Issued in WV
Legal business name
PENDLETON COMMUNITY CARE, INC.
Practice address
82 Pine St
Franklin, WV 26807-0100
Phone
(304) 358-2355
Fax
(304) 358-3054
NPI assigned
Jun 4, 2007
Last updated
Jul 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2016

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

Authorized official

Name
Jamie Hudson
Title
Ceo
Phone
(304) 358-7230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 51D0872802 WV Primary

Addresses

Primary practice location

82 Pine St
Franklin, WV 26807-0100

Mailing address

PO Box 100
Franklin, WV 26807-0100
Phone (304) 358-2355

Other identifiers 1

IdentifierTypeStateIssuer
3810006212MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217000523 WV Part B Supplier - Public Health/Welfare Agency 3678470614 Receives reassigned benefits from 25 practitioners
3 other NPIs on this enrollment
Practice locations: Franklin, WV; Riverton, WV

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0872802Pendleton Community Care82 Pine Street, Franklin, WV 26807Provider-performed microscopyJan 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pendleton Community Car10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Pendleton County High School-School Based Health CenterFranklin, WV, CCN 511055 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014
Franklin Elementary School - School Based Health CenterFranklin, WV, CCN 511056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014
North Fork Elementary School - School Based Health CenterCircleville, WV, CCN 511058 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014
Brandywine Elementary School - School Based Health CenterBrandywine, WV, CCN 511057 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468886400000",
    "number": "1265634059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "FRANKLIN",
            "state": "WV",
            "postal_code": "268070100",
            "telephone_number": "304-358-2355",
            "fax_number": "304-358-3054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 PINE ST",
            "city": "FRANKLIN",
            "state": "WV",
            "postal_code": "268070100",
            "telephone_number": "304-358-2355",
            "fax_number": "304-358-3054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON COMMUNITY CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2016-07-19",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-358-7230"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "51D0872802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006212",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Franklin, WV

Sources for this page

Verify at the official NPI Registry.