Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Practice address

1349 Shinnston Pike
Clarksburg, WV 26301-6307

Phone

(304) 622-0115

Fax

(304) 623-6220

NPI assigned

Oct 17, 2016

Organization subpart

No

Name

Dora L Potasnik

Title

Credentialing Coordinator

Phone

(304) 317-7275

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

• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863

  Corporate Officer

  CMS ownership
• Patricia L Collett, PA-C

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

  Corporate Officer

  CMS ownership
• Kevin Douglas Junkins, MD

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1629344858

  Corporate Officer

  CMS ownership

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa S Dodrill, M.D.

  • Family Medicine Physician
  • West Milford, WV
  • NPI 1871887349

  WV

  Medicare reassignment NPD
• Kyle Miller, MD

  • Family Medicine Physician
  • Bridgeport, WV
  • NPI 1386148013

  WV

  Medicare reassignment NPD
• Adam Christopher Stonestreet, LICSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1245704980

  WV

  Medicare reassignment NPD
• Jaclyn K Swick, PA-C

  • Physician Assistant
  • Weston, WV
  • NPI 1023332699

  WV

  Medicare reassignment NPD

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 511114

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

VICTORY ELEMENTARY SCHOOL WELLNESS CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 19, 2016

Last certification

Oct 19, 2016

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 1984 in WV

Enrollment address

1349 Shinnston Pike
Clarksburg, WV 26301-6307

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

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

Locations

• Victory Elementary Wellness Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 25, 2023.

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1669923538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1349 SHINNSTON PIKE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263016307",
            "telephone_number": "304-622-0115",
            "fax_number": "304-623-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1349 SHINNSTON PIKE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263016307",
            "telephone_number": "304-622-0115",
            "fax_number": "304-623-6220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "304-317-7275"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Elementary Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Community Care of West Virginia, Inc.
• Community Care of West Virginia, Inc.
• Community Care of West Virginia, Inc.
• Community Care of West Virginia, Inc.
• Community Care of West Virginia, Inc.
• Community Care of West Virginia,Inc.
• Comprecare Services, Inc
• Comprecare Services, Inc.
• Carrie Ann Compton
• Gerry Lynn Conners

• All providers in Clarksburg, WV
• 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 Jul 25, 2023; 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.