NPIMap

Organization Active NPI

New River Health Association, Inc.

Doing business as Gulf Family Practice Pharmacy

  • Clinic Pharmacy
  • Sophia, WV
National Provider Identifier
1609194505
Registry record updated Jan 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
SO0552404 Issued in WV
Legal business name
NEW RIVER HEALTH ASSOCIATION, INC.
Doing business as
Gulf Family Practice Pharmacy
New River Health Pharmacy - Lester Square
New River Health Pharmacy - Sophia
Practice address
821 Robert C. Byrd Dr.
Sophia, WV 25921
Phone
(304) 683-3809
Fax
(304) 683-5761
NPI assigned
May 17, 2010
Last updated
Jan 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2026

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

Authorized official

Name
Marissa Johnson
Title
Credentialing
Phone
(304) 469-2905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X SO0552404 WV Primary

Addresses

Primary practice location

821 Robert C. Byrd Dr.
Sophia, WV 25921

Mailing address

497 Mall Rd
Oak Hill, WV 25901-6216
Phone (304) 469-2905

Other identifiers 1

IdentifierTypeStateIssuer
SP0552404OtherWVBOARD OF PHARMACY

Other names 3

  • Gulf Family Practice Pharmacy Doing business as
  • New River Health Pharmacy - Lester Square Doing business as
  • New River Health Pharmacy - Sophia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071009000136 WV Part B Supplier - Public Health/Welfare Agency 2365348596 Receives reassigned benefits from 21 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coal City, WV; Lookout, WV; Oak Hill, WV; Sophia, WV; Summersville, WV
O20101102000834 WV Part A Provider - Federally Qualified Health Center (FQHC) 2365348596 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sophia, WV
O20210617000860 WV Part B Supplier - Mass Immunization (Roster Biller Only) 2365348596 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sophia, WV; Oak Hill, WV; Smithers, WV; Fayetteville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609194505. Details of each certification follow.

Federally qualified health center certification: CCN 511956

Legal name
NEW RIVER HEALTH ASSOCIATION INC
Doing business as
NEW RIVER HEALTH - SOPHIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2010
Last certification
Dec 15, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1976 in WV
Enrollment address
302 West Main St
Sophia, WV 25921-1283

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Joe Brouse Individual Other Apr 1, 2016
Angela M Barker Individual Corporate Officer Feb 1, 2014
Sharon Bradley Individual Other May 1, 2015
Nathan Hollister Individual Other Jan 1, 2020
Marissa Johnson Individual W-2 Managing Employee Jan 7, 2019
New River Health Association Inc Organization, Scarbro, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 27, 1976
Erin Reid Individual Other Jan 1, 2020
Robert Simmons Individual Corporate OfficerBoard Member Jul 1, 2006
Corporate Director Oct 1, 2010
Dustin White Individual Corporate Officer Sep 1, 2015
Paul Lively Individual Corporate OfficerBoard Member Jun 13, 2008
Corporate Director Oct 1, 2010
Rose Michaels Individual Other Nov 1, 2014
Gabriel Pena Individual Other Nov 1, 2013
John R Schultz Individual Corporate DirectorExe Director Jan 7, 2013
W-2 Managing EmployeeExe Director Jan 7, 2013
Evelyn Hizer Individual Corporate OfficerBoard Member Jul 1, 1995
Corporate Director Oct 1, 2010
Angela Sundstrom Individual Other Feb 1, 2016
Gary Hairston Individual Other Sep 1, 2012

Owners & managing parties with NPI records 23

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

View all 23

Practitioners & affiliated clinicians

Practitioners 1

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": "1274054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769472000000",
    "number": "1609194505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 MALL RD",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259016216",
            "telephone_number": "304-469-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 ROBERT C. BYRD DR.",
            "city": "SOPHIA",
            "state": "WV",
            "postal_code": "25921",
            "telephone_number": "304-683-3809",
            "fax_number": "304-683-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-17",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-469-2905"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "WV",
            "license": "SO0552404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "SP0552404",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Family Practice Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gulf Family Practice Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New River Health Pharmacy - Lester Square",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New River Health Pharmacy - Sophia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sophia, WV

Sources for this page

Verify at the official NPI Registry.