NPIMap

Organization Active NPI

New River Health Association, Inc.

  • Federally Qualified Health Center (FQHC)
  • Summersville, WV
National Provider Identifier
1407394646
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEW RIVER HEALTH ASSOCIATION, INC.
Practice address
315 Fairview Heights Rd
Summersville, WV 26651-1086
Phone
(304) 469-2905
Fax
(304) 465-5486
NPI assigned
Feb 8, 2017
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
Marissa Johnson
Title
Credentialing
Phone
(304) 469-2905

Specialties & licenses 1

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

Addresses

Primary practice location

315 Fairview Heights Rd
Summersville, WV 26651-1086

Mailing address

497 Mall Rd
Oak Hill, WV 25901-6216
Phone (304) 469-2905

Other names 1

  • New River Health - Summersville Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170505001123 WV Part A Provider - Federally Qualified Health Center (FQHC) 2365348596 Practice locations: Summersville, WV
O20170731000918 WV Part B Supplier - Clinic/Group Practice 2365348596 Receives reassigned benefits from 16 practitioners
Practice locations: Summersville, WV

Federally qualified health center certification: CCN 511124

Legal name
NEW RIVER HEALTH ASSOCIATION INC
Doing business as
NEW RIVER HEALTH - SUMMERSVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 2017
Last certification
Mar 9, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1976 in WV
Enrollment address
315 Fairview Heights Rd
Summersville, WV 26651-1086

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

National Provider Directory

National Provider Directory

Locations

30 Grizzley Ln
Summersville, WV 26651
Phone (304) 574-2905

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 OfficerBoard Member Apr 1, 2016
Angela M Barker Individual Corporate DirectorMedial Dir Feb 1, 2014
W-2 Managing EmployeeMedical Dir Feb 1, 2014
Sharon Bradley Individual Corporate OfficerBoard Member May 1, 2015
Nathan Hollister Individual Other Jan 1, 2020
Marissa Johnson Individual W-2 Managing Employee Jan 7, 2019
New River Health Association Inc Organization, Oak Hill, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2017
Erin Reid Individual Other Jan 1, 2020
Robert Simmons Individual Corporate OfficerVice Chair Board of Dir Jul 1, 2015
Paul Lively Individual Corporate OfficerBoard Member - Chair Jul 1, 1978
Rose Michaels Individual Other Nov 1, 2014
Gabriel Pena Individual Corporate OfficerBoard Member Nov 11, 2013
John R Schultz Individual Corporate DirectorCeo Jan 7, 2013
W-2 Managing EmployeeCeo Jan 7, 2013
Evelyn Hizer Individual Corporate OfficerSec - Board of Dir Jul 1, 1995
Angela Sundstrom Individual Corporate OfficerBoard Member Feb 1, 2016
Gary Hairston Individual Corporate OfficerBoard Member Sep 1, 2012

Owners & managing parties with NPI records 22

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

View all 22

All facility ownership & control disclosures 10

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
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 11

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1486512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1407394646",
    "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",
            "telephone_number": "304-469-2905",
            "fax_number": "304-465-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 FAIRVIEW HEIGHTS RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511086",
            "telephone_number": "304-469-2905",
            "fax_number": "304-465-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-08",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-469-2905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New River Health - Summersville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summersville, WV

Sources for this page

Verify at the official NPI Registry.