NPIMap

Organization Active NPI

Pendleton Community Care, Inc.

Doing business as Harman Health Center

  • Federally Qualified Health Center (FQHC)
  • Harman, WV
National Provider Identifier
1427307222
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENDLETON COMMUNITY CARE, INC.
Doing business as
Harman Health Center
Practice address
1 Mott Street
Harman, WV 26270-0014
Phone
(304) 227-4134
Fax
(304) 227-4522
NPI assigned
Sep 7, 2012
Last updated
Jun 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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

Authorized official

Name
Ms. Jamie Hudson
Title
Ceo
Phone
(304) 358-2355

Specialties & licenses 1

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

Addresses

Primary practice location

1 Mott Street
Harman, WV 26270-0014

Mailing address

PO Drawer 14
Harman, WV 26270-0014
Phone (304) 227-4134

Other identifiers 1

IdentifierTypeStateIssuer
3810026188MedicaidWV

Other names 1

  • Harman Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121114000473 WV Part A Provider - Federally Qualified Health Center (FQHC) 3678470614 Practice locations: Harman, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427307222. Details of each certification follow.

Federally qualified health center certification: CCN 511018

Legal name
PENDLETON COMMUNITY CARE INC
Doing business as
HARMAN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2013
Last certification
Apr 15, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 27, 1982 in WV
Enrollment address
15 Mott Street
Harman, WV 26270-0015

Other NPIs with the same Medicare PAC ID 8

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

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
51D2055369Harman Health Center15 Mott Street, Harman, WV 26270Provider-performed microscopyNov 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pendleton Community Car10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Mott St
Harman, WV 26270
Phone (304) 227-3661

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
Mary Cassell Individual Corporate DirectorBoard Vice-Chairman Jan 3, 2013
Robert Davis Individual Corporate Director Mar 3, 2016
Janice Heavner Individual Corporate Officer Jan 7, 2016
Jamie Hudson Individual Corporate OfficerPresident and Ceo Jun 1, 2016
W-2 Managing Employee Jul 19, 2005
Michelle Sites Individual Corporate Officer Apr 28, 1976
Joseph D Bucher Individual Corporate Director Jan 1, 2014
Nancy Bowers Individual Corporate DirectorBoard Secretary Jan 7, 2013
Melissa Grimes Individual Corporate Director Aug 5, 2021
Peggy Davis Individual Corporate Director Jan 1, 2001
Eugene McConnell Individual Corporate Director Jan 7, 2013
Larry Thomas Individual Corporate DirectorBoard Treasurer Jan 9, 2014
Isaac Sponaugle Individual Corporate Director Apr 3, 2014
Rebecca Lynn Eason Individual Corporate OfficerCfo Jun 1, 2016
W-2 Managing EmployeeCfo Jun 1, 2016

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Pendleton County High School-School Based Health CenterFranklin, WV, CCN 511055 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014
Franklin Elementary School - School Based Health CenterFranklin, WV, CCN 511056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014
North Fork Elementary School - School Based Health CenterCircleville, WV, CCN 511058 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014
Brandywine Elementary School - School Based Health CenterBrandywine, WV, CCN 511057 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2014

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1427307222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO DRAWER 14",
            "city": "HARMAN",
            "state": "WV",
            "postal_code": "262700014",
            "telephone_number": "304-227-4134",
            "fax_number": "304-227-4522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MOTT STREET",
            "city": "HARMAN",
            "state": "WV",
            "postal_code": "262700014",
            "telephone_number": "304-227-4134",
            "fax_number": "304-227-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON COMMUNITY CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-358-2355",
        "authorized_official_name_prefix": "Ms."
    },
    "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": "3810026188",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harman Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harman, WV

Sources for this page

Verify at the official NPI Registry.