Rockbridge Area Free Clinic
Organization Active NPI Federally Qualified Health Center (FQHC) · Lexington, VA
NPI 1508646571 · NPPES record last updated Oct 5, 2023
Key facts
- NPI
- 1508646571
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ROCKBRIDGE AREA FREE CLINIC
- Practice address
- 143 Greenhouse Rd
Lexington, VA 24450-3718 - Phone
- (540) 464-8700
- NPI assigned
- Oct 5, 2023
- Organization subpart
- No
Authorized official
- Name
- Valerie Suzanne Sheridan
- Title
- Ceo
- Phone
- (540) 464-8700
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 5
Practitioners 16
-
Angela Algire, PA
-
Kelsey Brown, RD
-
Michael David Henry, M.D.
-
Phornphan Moltane Homiak, PA-C
-
Denise Oinonen, LCSW
-
Laura Judith Simpson, FNP, PMHNP
-
Mayumi B Smitka, PA-C
-
Kerri F Stillwell, PA-C
-
Larry Stewart Berger, LPC
-
Sean P. Gannutz, PA-C
-
Mary T Zamora Lopez, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2307507 | Rockbridge County High School Health Center | Certificate of waiver | Jul 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Federally qualified health center certification: CCN 491017
- Legal name
- ROCKBRIDGE AREA FREE CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 4, 2023
- Last certification
- Dec 4, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 18, 1992 in VA
- Enrollment address
- 143 Greenhouse Rd
Lexington, VA 24450-3718
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia Jones |
Corporate Officer | May 1, 2017 | |
| Jane T Horton |
Corporate Officer | May 1, 2015 | |
| David a Dugan |
Corporate Officer | May 1, 2020 | |
| Valerie Suzanne Sheridan |
Corporate Officer | Feb 20, 2014 | |
| Operational/Managerial Control | Feb 20, 2014 | ||
| Dennis Cropper |
Corporate Officer | May 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240105004157 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 2860626231 | Practice locations: Lexington, VA |
National Provider Directory
- Tax ID family
- Rockbridge Area Free Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
143 Greenhouse Rd
Lexington, VA 24450-3718
Mailing address
25 Northridge LN
Lexington, VA 24450-3399
Phone (540) 464-8700
Other names
- Rockbridge County High School Health Center
Other providers in Lexington, VA
- Rockbridge Area Community Services Board
- Rockbridge Area Community Services Board
- Rockbridge Area Dept of Soc Ser
- Rockbridge Area Free Clinic
- Rockbridge Area Free Clinic
- Rockbridge Area Free Clinic
- Rockbridge Area Hospice, Inc
- Rockbridge Area Hospice, Inc
- Rockbridge Area Transportation System
- Rockbridge County Dental Clinic
All providers in Lexington, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.