Stony Creek Community Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

STONY CREEK COMMUNITY HEALTH CENTER

Practice address

12454 Hartley St
Stony Creek, VA 23882-3302

Phone

(434) 246-6100

Fax

(434) 246-6614

NPI assigned

Feb 6, 2006

Organization subpart

No

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

Authorized official

Name

Lucy J Elder

Title

Executive Director

Phone

(434) 246-3501

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 491803

Legal name

STONY CREEK COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 1, 1992

Last certification

Feb 1, 1992

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 9, 1987 in VA

Enrollment address

12454 Hartley St
Stony Creek, VA 23882-3302

Locations

All disclosed owners & managing parties 7

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Stony Creek Community Health Center

  • Community/Retail Pharmacy
  • Stony Creek, VA
  • NPI 1538268404
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Malalai Azmi, MD

  • Family Medicine Physician
  • Stony Creek, VA
  • NPI 1891766549
  Medicare reassignment Care Compare group NPD
• Brittani Danielle Jessup, FNP-BC

  • Family Nurse Practitioner
  • Stony Creek, VA
  • NPI 1124879150
  Medicare reassignment Care Compare group NPD
• Michael D Matherlee, MD

  • Family Medicine Physician
  • Stony Creek, VA
  • NPI 1164493813
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1376515031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12454 HARTLEY ST",
            "city": "STONY CREEK",
            "state": "VA",
            "postal_code": "238823302",
            "telephone_number": "434-246-6100",
            "fax_number": "434-246-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12454 HARTLEY ST",
            "city": "STONY CREEK",
            "state": "VA",
            "postal_code": "238823302",
            "telephone_number": "434-246-6100",
            "fax_number": "434-246-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY CREEK COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "ELDER",
        "authorized_official_first_name": "LUCY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "434-246-3501"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007636407",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael D Matherlee, MD
• New Way Community Living LLC
• Personal Touch Home Care Services, Inc.
• Drexel W Pierce Jr., ED.S.
• S&D First Solutions LLC
• Stony Creek Community Health Center
• Stony Creek Rescue Squad Inc
• Daquan Trisvan
• Howard Otto Wachsmann Jr., PHARMD

• Federally Qualified Health Center (FQHC) in Stony Creek, VA
• Providers in Stony Creek, VA by specialty
• Federally Qualified Health Center (FQHC) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.