NPIMap

Organization Active NPI

Williamson Health & Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Williamson, WV
National Provider Identifier
1467711150
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1875 Issued in WV
Legal business name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Practice address
184 E 2ND Ave
Suite 210
Williamson, WV 25661-3602
Phone
(304) 236-5902
Fax
(855) 487-4047
NPI assigned
May 15, 2012
Last updated
Jul 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Dr. Christopher Donovan Beckett, D.O.NPI 1174575898
Title
Medical Director
Phone
(304) 236-5902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1875 WV Primary

Addresses

Primary practice location

184 E 2ND Ave
Suite 210
Williamson, WV 25661-3602

Mailing address

PO Box 2080
Williamson, WV 25661-2080
Phone (304) 236-5902

Other identifiers 2

IdentifierTypeStateIssuer
1467711150MedicaidWV
7100283110MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, KY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20131205000501 WV Part A Provider - Federally Qualified Health Center (FQHC) 5395972996 Practice locations: Williamson, WV
O20140521000620 WV Part B Supplier - Clinic/Group Practice 5395972996 Receives reassigned benefits from 31 practitioners
8 other NPIs on this enrollment
Practice locations: Williamson, WV; Lavalette, WV; Matewan, WV; Delbarton, WV
O20200114002141 WV Part A Provider - Federally Qualified Health Center (FQHC) 5395972996 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williamson, WV
O20200805001818 KY Part B Supplier - Clinic/Group Practice 5395972996 Receives reassigned benefits from 3 practitioners
Practice locations: South Williamson, KY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1467711150. Details of each certification follow.

Federally qualified health center certification: CCN 511032

Legal name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2013
Last certification
Dec 5, 2013
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 12, 2011 in WV
Enrollment address
184 E 2ND Ave
Ste 210
Williamson, WV 25661-3602

Federally qualified health center certification: CCN 511177

Legal name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2019
Last certification
Nov 22, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2014 in WV
Enrollment address
859 Alderson St
Ste 1000
Williamson, WV 25661

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Christopher Donovan Beckett Individual Corporate DirectorMedical Director Jan 1, 2013 100%
W-2 Managing EmployeeMedical Director Jan 1, 2013 10%
5% Or Greater Direct Ownership InterestManagerial Dec 1, 2019 100%
Corporate OfficerCeo Dec 1, 2019 100%
Operational/Managerial ControlCeo Dec 1, 2019
Williamson Health & Wellness Center Inc Organization, Williamson, WV Non-profit Operational/Managerial Control Sep 3, 2013
David Jewell Individual Corporate DirectorCfo Jun 1, 2020

Owners & managing parties with NPI records 15

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

View all 15

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Williamson Health & Wellness Center- Behavioral Medicine ClinicWilliamson, WV, CCN 510094 Hospital 5% Or Greater Direct Ownership Interest (100%) May 31, 2020
Williamson Health & Wellness Center-Matewan PK-8Matewan, WV, CCN 581078 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1467711150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2080",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256612080",
            "telephone_number": "304-236-5902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 E 2ND AVE",
            "address_2": "SUITE 210",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613602",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSON HEALTH & WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-15",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "DONOVAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "304-236-5902",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "1875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467711150",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100283110",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamson, WV

Sources for this page

Verify at the official NPI Registry.