NPIMap

Organization Active NPI

Valley Health Systems, Inc

Doing business as Valley Health- Kanawha City

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
National Provider Identifier
1407466535
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY HEALTH SYSTEMS, INC
Doing business as
Valley Health- Kanawha City
Practice address
4407 Maccorkle Ave SE
Charleston, WV 25304-2541
Phone
(304) 925-0392
Fax
(304) 925-0396
NPI assigned
Aug 4, 2020
Last updated
Dec 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Authorized official

Name
Mary-Beth Brubeck
Title
VP Finance, Cfo
Phone
(304) 525-3334

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Nurse Practitioner 363LF0000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

4407 Maccorkle Ave SE
Charleston, WV 25304-2541

Mailing address

PO Box 1680
Huntington, WV 25717-1680
Phone (304) 697-1396

Other names 1

  • Valley Health- Kanawha City Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201121000107 WV Part B Supplier - Clinic/Group Practice 9931017969 Receives reassigned benefits from 28 practitioners
1 other NPI on this enrollment
Practice locations: Charleston, WV
O20201125002498 WV Part A Provider - Federally Qualified Health Center (FQHC) 9931017969 Practice locations: Charleston, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407466535. Details of each certification follow.

Federally qualified health center certification: CCN 511196

Legal name
VALLEY HEALTH SYSTEMS, INC
Doing business as
VALLEY HEALTH - KANAWHA CITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 17, 2020
Last certification
Nov 17, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 28, 2020 in WV
Enrollment address
4407 Maccorkle Ave SE
Charleston, WV 25304-2541

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D1001451Valley Health Kanawha City4407 Maccorkle Avenue, Charleston, WV 25304Certificate of waiverJul 10, 2028

National Provider Directory

National Provider Directory

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
Jared Colker Individual Corporate DirectorBoard Member Sep 28, 2020
Debra Zuberbuehler Individual Corporate DirectorBoard Member Jan 1, 2025
Paulette Mabry Individual Corporate DirectorBoard Member Sep 28, 2020
Suzi Brodof Individual Corporate DirectorBoard Member Sep 28, 2020
Mathew Weimer Individual Corporate OfficerPresident, Ceo Sep 28, 2024
W-2 Managing Employee Sep 28, 2024
Sherrone Hornbuckle Individual Corporate DirectorBoard Member Sep 28, 2020
Mark Queen Individual Corporate DirectorBoard Member Jan 1, 2026
Jonathan Ritchie Individual Corporate DirectorBoard Member Jan 1, 2026
Mary-Beth Brubeck Individual Corporate OfficerExecutive Vice President / Cfo Sep 28, 2020
Corporate DirectorExecutive Vice President / Cfo Sep 28, 2020
W-2 Managing EmployeeExecutive Vice President / Cfo Sep 28, 2020
Kalyn Obiozor Dorey Individual Corporate DirectorBoard Member Nov 22, 2022
Carol Bailey Individual Corporate DirectorBoard Member Jan 1, 2026
Benjamin L Howard Individual Corporate DirectorBoard Member Sep 28, 2020
Misty Vanhoose-Golden Individual Corporate DirectorBoard Member May 22, 2025

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 2

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

FacilityTypeRoleSince
Valley Health Apple GroveApple Grove, WV, CCN 581056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 16, 1975
Valley Health SCP - Charleston 108Charleston, WV, CCN 581062 Federally qualified health center Operational/Managerial Control Feb 1, 2024

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1407466535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1680",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257171680",
            "telephone_number": "304-697-1396",
            "fax_number": "304-697-2086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4407 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042541",
            "telephone_number": "304-925-0392",
            "fax_number": "304-925-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-04",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A",
        "authorized_official_last_name": "BRUBECK",
        "authorized_official_first_name": "MARY-BETH",
        "authorized_official_title_or_position": "VP FINANCE, CFO",
        "authorized_official_telephone_number": "304-525-3334"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health- Kanawha City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.