NPIMap

Organization Active NPI

Monroe County Health Center Board of Trustees

  • Federally Qualified Health Center (FQHC)
  • New Castle, VA
National Provider Identifier
1689122186
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Practice address
25239 Craigs Creek Rd
New Castle, VA 24127-6223
Phone
(540) 864-6322
NPI assigned
Sep 14, 2016
Last updated
Sep 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

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

Authorized official

Name
Michelle Ballard
Title
Coo
Phone
(302) 772-3064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

25239 Craigs Creek Rd
New Castle, VA 24127-6223

Mailing address

PO Box 590
Union, WV 24983-0590

Other names 1

  • CRAIG COUNTY WELLNESS CENTER Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161230001421 VA Part A Provider - Federally Qualified Health Center (FQHC) 3173432671 Practice locations: New Castle, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689122186. Details of each certification follow.

Federally qualified health center certification: CCN 491952

Legal name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Doing business as
CRAIG COUNTY WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 18, 2016
Last certification
Nov 18, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2003 in WV
Enrollment address
25239 Craigs Creek Rd
New Castle, VA 24127-6223

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Monroe County Health Center Board of Trustees11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the 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
Salvatore Bellassai Individual Corporate Officer Jul 27, 2022
James Holtman Individual Corporate Officer Sep 1, 2017
Richard Miller Individual Corporate Officer Jan 1, 2020
Vaden R Tabor Individual Corporate Officer May 1, 2018
Wayne D Spangler Individual Corporate DirectorBoard Member Jan 1, 2015
Scott King Individual Corporate Officer Aug 25, 2021
Shirley H Dixon Individual Corporate DirectorBoard Member Jan 1, 2013
Amy Mann Individual Corporate Officer Apr 1, 2018
Walter Marsden Individual Corporate DirectorBoard Member Jan 1, 2011
Janet W Caulkins Individual Corporate DirectorBoard Member Jan 1, 2015
Michelle Ballard Individual Corporate OfficerCoo Sep 1, 2011
Corporate Director Sep 1, 2011
W-2 Managing EmployeeCoo Sep 1, 2011
Jeffry a Pritt Individual Corporate DirectorBoard Member Jan 1, 2013
Melissa F Boggs Individual Corporate DirectorSecretary Jan 1, 2013

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Craig County Health CenterNew Castle, VA, CCN 491881 Federally qualified health center Operational/Managerial Control (100%) Aug 30, 2007
Monroe Health CenterUnion, WV, CCN 511837 Federally qualified health center Operational/Managerial Control (100%) Jun 30, 2006

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1689122186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "UNION",
            "state": "WV",
            "postal_code": "249830590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25239 CRAIGS CREEK RD",
            "city": "NEW CASTLE",
            "state": "VA",
            "postal_code": "241276223",
            "telephone_number": "540-864-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-14",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "302-772-3064"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRAIG COUNTY WELLNESS CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Castle, VA

Sources for this page

Verify at the official NPI Registry.