NPIMap

Organization Active NPI

New River Health Association, Inc.

Doing business as Lisa Elliott Health Center

  • Federally Qualified Health Center (FQHC)
  • Lookout, WV
National Provider Identifier
1346426103
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1036-9138 Issued in WV
Legal business name
NEW RIVER HEALTH ASSOCIATION, INC.
Doing business as
Lisa Elliott Health Center
Practice address
75 Spy Rock Loop Road
Lookout, WV 25868
Phone
(304) 574-2076
Fax
(304) 574-1068
NPI assigned
Jan 11, 2008
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
John R. Schultz
Title
Executive Director
Phone
(304) 469-2905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1036-9138 WV Primary

Addresses

Primary practice location

75 Spy Rock Loop Road
Lookout, WV 25868

Mailing address

497 Mall Rd
Oak Hill, WV 25901-6216

Other identifiers 1

IdentifierTypeStateIssuer
0035165000MedicaidWV

Other names 1

  • Lisa Elliott Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071009000136 WV Part B Supplier - Public Health/Welfare Agency 2365348596 Receives reassigned benefits from 21 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coal City, WV; Lookout, WV; Oak Hill, WV; Sophia, WV; Summersville, WV
O20080129000452 WV Part A Provider - Federally Qualified Health Center (FQHC) 2365348596 Practice locations: Lookout, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346426103. Details of each certification follow.

Federally qualified health center certification: CCN 511937

Legal name
NEW RIVER HEALTH ASSOCIATION INC
Doing business as
LISA ELLIOTT HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 28, 2008
Last certification
Mar 28, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1976 in WV
Enrollment address
75 Spyrock Loop Rd
Lookout, WV 25868-1100

Other NPIs with the same Medicare PAC ID 21

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

View all 21

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Joe Brouse Individual Corporate Director Apr 1, 2016
Angela M Barker Individual Corporate Officer Feb 1, 2014
Sharon Bradley Individual Corporate Director May 1, 2015
Nathan Hollister Individual Corporate Director Jan 1, 2020
Marissa Johnson Individual W-2 Managing EmployeeCredentialing Officer Mar 1, 2019
Erin Reid Individual Corporate Director Jan 1, 2020
Robert Simmons Individual Corporate Director Jul 1, 2006
Paul Lively Individual Corporate Director Jul 1, 1978
Rose Michaels Individual Corporate Director Nov 1, 2014
Gabriel Pena Individual Corporate Director Nov 11, 2013
John R Schultz Individual Corporate DirectorExecutive Director Jan 9, 2013
W-2 Managing EmployeeChief Executive Officer Jan 9, 2013
Evelyn Hizer Individual Corporate Director Jul 1, 1995
Steve Pawlus Individual Corporate Director Aug 27, 2020
Angela Sundstrom Individual Corporate Director Feb 1, 2016
Gary Hairston Individual Corporate Director Sep 1, 2012

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 11

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

FacilityTypeRoleSince
New River Health - SophiaSophia, WV, CCN 511956 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Intermediate School Based Health CenterOak Hill, WV, CCN 511963 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
Oak Hill High School Based Health CenterOak Hill, WV, CCN 511962 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Nicholas County School Based Health CenterSummersville, WV, CCN 511965 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Coal City Elementary School Based Health CenterCoal City, WV, CCN 511969 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Independence School Based Health CenterCoal City, WV, CCN 511970 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Health - SummersvilleSummersville, WV, CCN 511124 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 1, 2017
Independence Middle School Based Health CenterCoal City, WV, CCN 511161 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 26, 2018
Jun 26, 2018
Fayetteville PK-8 School Based Health CenterFayetteville, WV, CCN 511179 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - SmithersSmithers, WV, CCN 511189 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - Oak HillOak Hill, WV, CCN 581809 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976

Owned or controlled facilities with NPI records 12

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

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1346426103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 MALL RD",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259016216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SPY ROCK LOOP ROAD",
            "city": "LOOKOUT",
            "state": "WV",
            "postal_code": "25868",
            "telephone_number": "304-574-2076",
            "fax_number": "304-574-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-469-2905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "1036-9138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035165000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lisa Elliott Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lisa Elliott Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lookout, WV

Sources for this page

Verify at the official NPI Registry.