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Organization Active NPI

Winchester Medical Center

  • Rural Health Clinic/Center
  • Winchester, VA
National Provider Identifier
1467045922
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WINCHESTER MEDICAL CENTER
Practice address
160 Merchant St Ste 100
Winchester, VA 22603-4772
Phone
(540) 536-5560
Fax
(540) 536-5561
NPI assigned
Feb 16, 2021
Organization subpart
Yes
Parent organization
WINCHESTER MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Renee Nevada Johnson
Title
Credentialing Coordinator
Phone
(540) 536-0103

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

160 Merchant St Ste 100
Winchester, VA 22603-4772

Mailing address

220 Campus Blvd Ste 100
Winchester, VA 22601-2896
Phone (540) 536-5100

Other names 1

  • Valley Health Winchester Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031124000061 VA Part B Supplier - Clinic/Group Practice 0244134021 Receives reassigned benefits from 866 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winchester, VA; Woodstock, VA; Front Royal, VA; Luray, VA
O20210419001099 VA Part A Provider - Rural Health Clinic 0244134021 Practice locations: Winchester, VA

Rural health clinic certification: CCN 493460

Legal name
WINCHESTER MEDICAL CENTER
Doing business as
VALLEY HEALTH WINCHESTER FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 5, 2021
Last certification
May 5, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 8, 1984 in VA
Enrollment address
160 Merchant St
Ste 100
Winchester, VA 22603-4772
Related CCNs
490005

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 21

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

View all 21

National Provider Directory

National Provider Directory
Part of
Winchester Med Ctr Labo

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Winchester Medical Center Organization, Winchester, VA Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 1, 2021 5%
Robert M Amos Individual Corporate OfficerVP Oct 4, 2009
Valley Health System Organization, Winchester, VA Corporation 5% Or Greater Direct Ownership Interest May 1, 2021 5%
Jill Chambers Individual W-2 Managing Employee Sep 1, 2017

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Valley Health Home Health/West VirginiaRomney, WV, CCN 517075 Home health agency 5% Or Greater Direct Ownership Interest (33.3%) Nov 1, 2006

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 327

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

View all 327

NPI Registry JSON

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1467045922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CAMPUS BLVD STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012896",
            "telephone_number": "540-536-5100",
            "fax_number": "540-536-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 MERCHANT ST STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226034772",
            "telephone_number": "540-536-5560",
            "fax_number": "540-536-5561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINCHESTER MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINCHESTER MEDICAL CENTER",
        "enumeration_date": "2021-02-16",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "NEVADA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "540-536-0103"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health Winchester Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health Winchester Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winchester, VA

Sources for this page

Verify at the official NPI Registry.