NPIMap

Organization Active NPI

Valley Health Systems, Inc.

Doing business as Valley Health FoodFair Rt 60

  • Federally Qualified Health Center (FQHC)
  • Barboursville, WV
National Provider Identifier
1659733293
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY HEALTH SYSTEMS, INC.
Doing business as
Valley Health FoodFair Rt 60
Practice address
6350 US Route 60 E
Barboursville, WV 25504
Phone
(304) 399-3350
Fax
(304) 697-2086
NPI assigned
Mar 23, 2016
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mary-Beth Brubeck
Title
Vice President of Finance / Cfo
Phone
(304) 525-3334

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

6350 US Route 60 E
Barboursville, WV 25504

Mailing address

2585 3Rd Ave
Huntington, WV 25703-1642
Phone (304) 697-1396

Other names 1

  • Valley Health FoodFair Rt 60 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160511001131 WV Part A Provider - Federally Qualified Health Center (FQHC) 9931017969 Practice locations: Barboursville, WV
O20160824002521 WV Part B Supplier - Clinic/Group Practice 9931017969 Receives reassigned benefits from 56 practitioners
1 other NPI on this enrollment
Practice locations: Barboursville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659733293. Details of each certification follow.

Federally qualified health center certification: CCN 511098

Legal name
VALLEY HEALTH SYSTEMS, INC
Doing business as
VALLEY HEALTH FOODFAIR RT 60
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 18, 2016
Last certification
Apr 18, 2016
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Apr 13, 2016 in WV
Enrollment address
6350 US Route 60 E
Barboursville, WV 25504-1232

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

6350 US Route 60 E
Barboursville, WV 25504
Phone (304) 399-3350

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 Perry Individual Corporate DirectorMember/Board of Directors Feb 1, 1994
Christina Walter Individual Corporate DirectorMember/Board of Directors Apr 25, 2019
Steven Leigh Shattls Individual Corporate OfficerPresident/Ceo Jan 1, 1975
W-2 Managing Employee Jan 1, 1975
Jared Colker Individual Corporate DirectorMember/Board of Directors Dec 8, 2016
Paulette Mabry Individual Corporate DirectorMember/Board of Directors Dec 8, 2016
Bill Bryant Individual Corporate DirectorMember/Board of Directors Apr 28, 2011
Suzi Brodof Individual Corporate DirectorMember/Board of Directors Oct 26, 2017
Sherrone Hornbuckle Individual Corporate DirectorMember/Board of Directors Oct 26, 2017
Mary-Beth Brubeck Individual Corporate OfficerVP of Finance/Cfo Jan 1, 2019
W-2 Managing Employee Jan 1, 2019
Kalyn Obiozor Dorey Individual Corporate DirectorMember/Board of Directors Nov 22, 2022
Greg Agee Individual Corporate DirectorVice Chair/Board of Directors Jan 27, 2005
Jill Hutchinson Individual Corporate DirectorChair/Board of Directors Jan 27, 2005
Benjamin L Howard Individual Corporate DirectorMember/Board of Directors Jan 1, 2003

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Valley Health Apple GroveApple Grove, WV, CCN 581056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 16, 1975
Valley Health SCP - Charleston 108Charleston, WV, CCN 581062 Federally qualified health center Operational/Managerial Control Feb 1, 2024

Practitioners & affiliated clinicians

Practitioners 57

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 57

NPI Registry JSON

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1659733293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2585 3RD AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257031642",
            "telephone_number": "304-697-1396",
            "fax_number": "304-697-2086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6350 US ROUTE 60 E",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "25504",
            "telephone_number": "304-399-3350",
            "fax_number": "304-697-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY HEALTH SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "BRUBECK",
        "authorized_official_first_name": "MARY-BETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE / CFO",
        "authorized_official_telephone_number": "304-525-3334"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health FoodFair Rt 60",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health FoodFair Rt 60",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barboursville, WV

Sources for this page

Verify at the official NPI Registry.