NPIMap

Organization Active NPI

Pendleton Community Care Inc

  • Clinical Medical Laboratory
  • Harman, WV
National Provider Identifier
1437401643
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PENDLETON COMMUNITY CARE INC
Practice address
1 Mott Street
Harman, WV 26270-0014
Phone
(304) 227-4134
Fax
(304) 227-4522
NPI assigned
Oct 11, 2012
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 8

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

Practitioners 41

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

View all 41

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130717000824 WV Part B Supplier - Clinic/Group Practice 3678470614 Receives reassigned benefits from 8 practitioners
Practice locations: Harman, WV

All facility ownership & control disclosures 4

Medicare enrollment files

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

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

NPPES NPI Registry

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

NPPES NPI Registry
IdentifierTypeStateIssuer
3810025983MedicaidWV

Other names 1

NPPES NPI Registry
  • Harman Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 14, 2016.

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1437401643",
    "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": "2012-10-11",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810025983",
            "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.