Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

2287-8118 Issued in WV

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

Big Elm Elementary Wellness Center

Practice address

200 Tetrick Rd
Shinnston, WV 26431-9704

Phone

(304) 326-7280

Fax

(304) 326-7293

NPI assigned

Jun 26, 2013

Last updated

Jun 26, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

COMMUNITY CARE OF WEST VIRGINIA, INC.As reported in NPPES

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

Authorized official

Name

Dora L Potasnik

Title

Credentialing

Phone

(304) 587-2541

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Big Elm Elementary Wellness Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649610437. Details of each certification follow.

• CCN 511039 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 511039

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

BUCKHANNON-UPSHUR MIDDLE SCHOOL WELLNESS CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 5, 2013

Last certification

Nov 5, 2013

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 1984 in WV

Enrollment address

303 RR 6
Buckhannon, WV 26201-8830

Other NPIs on the same Medicare enrollment 1

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

• Community Care of West Virginia, Inc.

  dba Buckhannon Upshur Middle School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Buckhannon, WV
  • NPI 1992144273

  O20131028001724

  Same enrollment

Part of

Primary Care Systems Inc

Locations

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 2

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

• Sarah B Chouinard, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1023087954

  Corporate Officer

  CMS ownership
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760

  Corporate Officer

  CMS ownership

All facility ownership & control disclosures 1

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

Practitioners 80

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.

• Joshua Scott Abbott, DDS

  • Dentist
  • Green Bank, WV
  • NPI 1891041406
  Medicare reassignment NPD
• Laura Evelyn Abbott, DDS

  • Dentist
  • Green Bank, WV
  • NPI 1093061608
  Medicare reassignment NPD
• Allyson Malone Andrews, PA-C

  • Medical Physician Assistant
  • Buckhannon, WV
  • NPI 1164405569
  Medicare reassignment NPD
• Nicholas Joel Baker, PA-C

  • Physician Assistant
  • Buckhannon, WV
  • NPI 1225177504
  Medicare reassignment NPD
• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863
  Medicare reassignment NPD
• Sarah Bell, DNP

  • Family Nurse Practitioner
  • Weston, WV
  • NPI 1841706884
  Medicare reassignment NPD
• Angela Gayle Carter, APRN, BC

  • Family Nurse Practitioner
  • Clay, WV
  • NPI 1083806277
  Medicare reassignment NPD
• Sarah B Chouinard, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1023087954
  Medicare reassignment NPD
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760
  Medicare reassignment NPD
• Melissa S Dodrill, M.D.

  • Family Medicine Physician
  • West Milford, WV
  • NPI 1871887349
  Medicare reassignment NPD
• Kelly W Dunavant, DO

  • Pain Medicine Physician
  • West Milford, WV
  • NPI 1609047109
  Medicare reassignment NPD
• Christina B Gillenwater, MD

  • Family Medicine Physician
  • Sutton, WV
  • NPI 1770876021
  Medicare reassignment NPD

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372204800000",
    "number": "1649610437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TETRICK RD",
            "city": "SHINNSTON",
            "state": "WV",
            "postal_code": "264319704",
            "telephone_number": "304-326-7280",
            "fax_number": "304-326-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-06-26",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "2287-8118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "2287-8118",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Big Elm Elementary Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lesly Brown
• Ashley Butcher, CFTS
• Dallas Ann Cantrell
• Karl D Clarkson, DC
• Community Care of West Virginia, Inc. (Lincoln High School Wellness Center)
• Charles Michael Darway
• Danielle Marie Del Rio
• Bradley Lee Diperna
• Tillie Marie Diperna
• John David Donaldson Jr., P.T, D.P.T.

• Federally Qualified Health Center (FQHC) in Shinnston, WV
• Providers in Shinnston, WV by specialty
• Federally Qualified Health Center (FQHC) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.