NPIMap

Organization Active NPI

Johnson Health Center

  • Federally Qualified Health Center (FQHC)
  • Lynchburg, VA
National Provider Identifier
1316926538
Registry record updated Apr 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JOHNSON HEALTH CENTER
Practice address
320 Federal St
Lynchburg, VA 24504-2306
Phone
(434) 947-5967
Fax
(434) 947-5255
NPI assigned
Jan 16, 2006
Last updated
Apr 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2015

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

Authorized official

Name
Gary Campbell
Title
Ceo
Phone
(434) 455-2480

Specialties & licenses 1

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

Addresses

Primary practice location

320 Federal St
Lynchburg, VA 24504-2306

Mailing address

134 Elon Rd
Madison Heights, VA 24572-2536
Phone (434) 455-2480

Other identifiers 2

IdentifierTypeStateIssuer
010064988MedicaidVA
DC4704OtherVARAILROAD MEDICARE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040114000510 VA Part A Provider - Federally Qualified Health Center (FQHC) 9537060413 1 other NPI on this enrollment
Practice locations: Lynchburg, VA
O20040709000047 VA Part B Supplier - Clinic/Group Practice 9537060413 Receives reassigned benefits from 73 practitioners
4 other NPIs on this enrollment
Practice locations: Bedford, VA; Lynchburg, VA; Madison Heights, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316926538. Details of each certification follow.

Federally qualified health center certification: CCN 491859

Legal name
JOHNSON HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 17, 2004
Last certification
Feb 17, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in VA
Enrollment address
320 Federal St
Lynchburg, VA 24504-2306

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

109 Clearview Rd
Madison Heights, VA 24572
Phone (434) 929-1400

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Sherry Gentry Individual Corporate DirectorMember Mar 18, 2016
Mary Brophy Individual Corporate DirectorSecretary Aug 18, 2014
Destin Tanner Individual Corporate DirectorMember Nov 21, 2021
Gary Campbell Individual Corporate OfficerCeo Aug 1, 2014
W-2 Managing EmployeeCeo Aug 1, 2014
James Tyler Individual Corporate DirectorMember Nov 21, 2021
Sandy Glass Individual Corporate DirectorTreasurer Mar 18, 2017
Gary Hutcherson Individual Corporate DirectorVice Chair Dec 17, 2018
Jennifer Hall Individual Corporate DirectorMember Mar 18, 2017
Debra Wood Drake Individual Corporate DirectorChair May 19, 2014
Mehgan McCrickard Individual Operational/Managerial ControlChief Operations Officier Aug 10, 2009
Robert Golcheski Individual Corporate DirectorMember Mar 18, 2016
Theresa McCrickard Individual Corporate DirectorMember Mar 18, 2016
Arthur F Fisher Individual Corporate DirectorMember Aug 26, 2019

Practitioners & affiliated clinicians

Practitioners 73

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 73

NPI Registry JSON

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

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1316926538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ELON RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "245722536",
            "telephone_number": "434-455-2480",
            "fax_number": "434-455-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 FEDERAL ST",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245042306",
            "telephone_number": "434-947-5967",
            "fax_number": "434-947-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-16",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "434-455-2480"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010064988",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC4704",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.