NPIMap

Organization Active NPI

Augusta Medical Group

Doing business as Augusta Health Maury River Family Practice

  • Rural Health Clinic/Center
  • Glasgow, VA
National Provider Identifier
1295318525
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AUGUSTA MEDICAL GROUP
Doing business as
Augusta Health Maury River Family Practice
Practice address
730 McCulloch St
Glasgow, VA 24555-2710
Phone
(540) 258-1700
NPI assigned
May 4, 2021
Last updated
May 4, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
AUGUSTA HEALTH CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 4, 2021

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

Authorized official

Name
Joseph Just
Title
President
Phone
(540) 258-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

730 McCulloch St
Glasgow, VA 24555-2710

Mailing address

730 McCulloch St
Glasgow, VA 24555-2710
Phone (540) 258-1700

Other names 1

  • Augusta Health Maury River Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210518000073 VA Part A Provider - Rural Health Clinic 3678632544 Practice locations: Glasgow, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295318525. Details of each certification follow.

Rural health clinic certification: CCN 498934

Legal name
AUGUSTA MEDICAL GROUP
Doing business as
AUGUSTA HEALTH MAURY RIVER FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 15, 2021
Last certification
Dec 15, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 18, 2008 in VA
Enrollment address
730 McCulloch St
Glasgow, VA 24555-2710

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Ah Maury River Family Practice2 organizations share this tax ID, including this one
Part of
Augusta Medical Center

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

540 Radford Ln
Ste 250
Charlottesville, VA 22903
Phone (434) 823-7596

22 N Medical Park Dr
Fishersville, VA 22939
Phone (540) 213-2630

53 S Medical Park Dr
Fishersville, VA 22939
Phone (540) 332-5687

55 Comfort Way
Ste 1
Lexington, VA 24450
Phone (540) 463-3381

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Augusta Health Care Inc Organization, Fishersville, VA Non-profit 5% Or Greater Direct Ownership Interest Mar 18, 2008 100%
Scott Crabtree Individual Corporate Officer Aug 16, 2010
W-2 Managing Employee Aug 16, 2010
John E Mack Individual Corporate OfficerChief Operating Officer Sep 1, 2018
William J Meador Individual Corporate Officer May 22, 2023
W-2 Managing Employee May 22, 2023
Crystal Farmer Individual Corporate Officer Aug 6, 2018
W-2 Managing Employee Aug 6, 2018
Susan Knick Individual W-2 Managing EmployeeMedical Office Manager Apr 16, 2020
Mary Mannix Individual Corporate OfficerPresident & Ceo Jan 1, 2008
W-2 Managing EmployeePresident & Ceo Jan 1, 2008
Richard Evans Individual Corporate DirectorDirector Apr 1, 2012
Shelley L Snodgrass Individual Corporate DirectorMedical Director, Primary Care Sep 25, 2006
W-2 Managing EmployeeMedical Director, Primary Care Sep 25, 2006
Kari O Lightner Individual W-2 Managing EmployeePractice Administrator II Feb 15, 2021
Jason M Lawrence Individual Corporate DirectorBoard Member Mar 19, 2020
Albert Morriss Individual Corporate DirectorChairman, Amb Board of Directors Apr 1, 2013
Kerry a Alexander Individual Corporate DirectorBoard Member Oct 1, 2016
Jacqueline Sims Individual Corporate DirectorAdministrative Director of Clinical Mar 10, 1991
W-2 Managing EmployeeAdministrative Director of Clinical Mar 10, 1991

Owners & managing parties with NPI records 12

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620086400000",
    "number": "1295318525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 MCCULLOCH ST",
            "city": "GLASGOW",
            "state": "VA",
            "postal_code": "245552710",
            "telephone_number": "540-258-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 MCCULLOCH ST",
            "city": "GLASGOW",
            "state": "VA",
            "postal_code": "245552710",
            "telephone_number": "540-258-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AUGUSTA HEALTH CARE, INC.",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "JUST",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-258-1700"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Augusta Health Maury River Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glasgow, VA

Sources for this page

Verify at the official NPI Registry.