NPIMap

Organization Active NPI

Johnson Health Center

Doing business as Bedford Community Health Center

  • Community Health Clinic/Center
  • Bedford, VA
National Provider Identifier
1609203538
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
JOHNSON HEALTH CENTER
Doing business as
Bedford Community Health Center
Practice address
582 Blue Ridge Ave
Bedford, VA 24523-2604
Phone
(434) 929-1400
Fax
(434) 929-0410
NPI assigned
Oct 10, 2013
Last updated
Dec 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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

Authorized official

Name
Mr. Gary Campbell
Title
Ceo
Phone
(434) 455-2480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

582 Blue Ridge Ave
Bedford, VA 24523-2604

Mailing address

134 Elon Rd
Madison Heights, VA 24572-2536
Phone (434) 455-2480

Other names 1

  • Bedford Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040709000047 VA Part B Supplier - Clinic/Group Practice 9537060413 Receives reassigned benefits from 73 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bedford, VA; Lynchburg, VA; Madison Heights, VA
O20131206000793 VA Part A Provider - Federally Qualified Health Center (FQHC) 9537060413 Practice locations: Bedford, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609203538. Details of each certification follow.

Federally qualified health center certification: CCN 491926

Legal name
JOHNSON HEALTH CENTER
Doing business as
BEDFORD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2013
Last certification
Dec 6, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in VA
Enrollment address
582 Blue Ridge Avenue
Bedford, VA 24523

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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 13

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

NameRoleSinceShare
Sherry Gentry Individual Corporate DirectorMember Jul 8, 2016
Mary Brophy Individual Corporate DirectorSecretary Aug 18, 2014
Destin Tanner Individual Corporate DirectorMember Nov 21, 2021
Gary Campbell Individual Corporate DirectorCeo Aug 1, 2014
W-2 Managing EmployeeCeo Aug 1, 2014
James Tyler Individual Corporate DirectorMember Nov 21, 2021
Sandy Glass Individual Corporate DirectorTreasurer Jul 9, 2017
Gary Hutcherson Individual Corporate DirectorVice Chair Dec 17, 2018
Jennifer Hall Individual Corporate DirectorMember Jul 9, 2017
Debra Wood Drake Individual Corporate DirectorChair May 19, 2014
Mehgan McCrickard Individual Corporate DirectorChief Operating Officer Aug 1, 2014
Operational/Managerial ControlChief Operating Officer Aug 1, 2014
Robert Golcheski Individual Corporate DirectorMember Jul 8, 2016
Theresa McCrickard Individual Corporate DirectorMember Jul 8, 2016
Arthur F Fisher Individual Corporate DirectorMember Aug 26, 2019

Practitioners & affiliated clinicians

Practitioners 10

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": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1609203538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ELON RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "245722536",
            "telephone_number": "434-455-2480",
            "fax_number": "434-455-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "582 BLUE RIDGE AVE",
            "city": "BEDFORD",
            "state": "VA",
            "postal_code": "245232604",
            "telephone_number": "434-929-1400",
            "fax_number": "434-929-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "434-455-2480",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bedford Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bedford, VA

Sources for this page

Verify at the official NPI Registry.