NPIMap

Organization Active NPI

Free Clinic of the New River Valley Inc

Doing business as Giles Clinic

  • Federally Qualified Health Center (FQHC)
  • Pearisburg, VA
National Provider Identifier
1306273149
Registry record updated Oct 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FREE CLINIC OF THE NEW RIVER VALLEY INC
Doing business as
Giles Clinic
Practice address
219 Buchanan St
Pearisburg, VA 24134-1901
Phone
(540) 921-3502
Fax
(540) 382-3391
NPI assigned
Oct 10, 2013
Last updated
Oct 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2013

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

Authorized official

Name
Mrs. Michelle Brauns
Title
Executive Director
Phone
(540) 381-0820

Specialties & licenses 1

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

Addresses

Primary practice location

219 Buchanan St
Pearisburg, VA 24134-1901

Mailing address

215 Roanoke St
Christiansburg, VA 24073-3025
Phone (540) 381-0820

Other names 1

  • Giles Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140109000945 VA Part A Provider - Federally Qualified Health Center (FQHC) 5294963666 Practice locations: Pearisburg, VA
O20140414001357 VA Part B Supplier - Clinic/Group Practice 5294963666 Receives reassigned benefits from 24 practitioners
Practice locations: Pearisburg, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306273149. Details of each certification follow.

Federally qualified health center certification: CCN 491930

Legal name
FREE CLINIC OF THE NEW RIVER VALLEY INC
Doing business as
GILES CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2014
Last certification
Jan 9, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 7, 1979 in VA
Enrollment address
239 Buchanan Street
Pearisburg, VA 24131-1901

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Locations

215 Roanoke St
Christiansburg, VA 24073
Phone (540) 381-0820

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
Matthew Pitonyak Individual W-2 Managing EmployeeCfo Sep 10, 2020
Operational/Managerial ControlCfo Sep 10, 2020
Anthony Ramsey Individual Corporate Director Jan 6, 2014
Cathy McDowell Individual Corporate Director Jan 6, 2014
James Bohland Individual Corporate Director Jan 6, 2014
Kristi Eaton Individual Corporate Director Jan 6, 2014
Margot Thompson Individual Corporate Director Jan 6, 2014
Pat Hyer Individual Corporate Director Jan 6, 2014
Michelle Brauns Individual Corporate DirectorExecutive Director Jan 6, 2014
W-2 Managing EmployeeExecutive Director Jan 6, 2014
Tracy Cohn Individual Corporate Director May 1, 2012
Keith Finch Individual Corporate Director Jan 6, 2014
Patricia Gaudreau Individual Corporate Director Jan 6, 2014
John Bouldin Individual Corporate Director Jan 6, 2014
Amy Westmoreland Individual Corporate Director Jan 6, 2014
Lynne Knox Individual Corporate Director Jan 6, 2014

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1306273149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 ROANOKE ST",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240733025",
            "telephone_number": "540-381-0820",
            "fax_number": "540-382-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 BUCHANAN ST",
            "city": "PEARISBURG",
            "state": "VA",
            "postal_code": "241341901",
            "telephone_number": "540-921-3502",
            "fax_number": "540-382-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE CLINIC OF THE NEW RIVER VALLEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "BRAUNS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "540-381-0820",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Giles Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pearisburg, VA

Sources for this page

Verify at the official NPI Registry.