NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

Doing business as French Creek Elementary School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • French Creek, WV
National Provider Identifier
1689921082
Registry record updated Aug 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
French Creek Elementary School Wellness Center
Practice address
RR 2 Box 305
French Creek, WV 26218-9667
Phone
(304) 924-6381
Fax
(304) 924-5460
NPI assigned
Aug 6, 2012
Last updated
Aug 6, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2012

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

Authorized official

Name
Richard G Simon
Title
Ceo
Phone
(304) 924-6262

Specialties & licenses 1

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

Addresses

Primary practice location

RR 2 Box 305
French Creek, WV 26218-9667

Mailing address

RR 2 Box 305
French Creek, WV 26218-9667
Phone (304) 924-6381

Other names 1

  • French Creek Elementary School Wellness Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071024000166 WV Part B Supplier - Public Health/Welfare Agency 0446232987 Receives reassigned benefits from 74 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clay, WV; Buckhannon, WV; West Milford, WV; Rock Cave, WV; Marlinton, WV; Ivydale, WV; Helvetia, WV; Green Bank, WV…
O20121003000357 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: French Creek, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689921082. Details of each certification follow.

Federally qualified health center certification: CCN 511987

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
FRENCH CREEK ELEMENTARY SCHOOL WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 3, 2012
Last certification
Oct 3, 2012
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
RR2, Box 305
French Creek, WV 26218-9667

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Community Care of West Virginia

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sarah Chouinard Individual Corporate OfficerMedical Director Sep 1, 2004
Dora L. Potasnik Individual W-2 Managing EmployeeCredentialing Jan 9, 2012
Karen E Grant Individual Corporate DirectorBoard Member/Secretary Apr 1, 2011
Thomas G Lynch Individual Corporate DirectorBoard Member/President Jul 1, 2007
Michele Williams Individual Corporate OfficerCompliance Officer Dec 12, 2005
Richard G Simon Individual Corporate OfficerCeo Sep 13, 1993 100%
Connie a Johnston Individual Corporate OfficerCfo Mar 1, 2014
David D Taylor Individual Corporate DirectorBoard Member Mar 14, 2016
Renee a Hofer Individual Corporate DirectorBoard Member Jul 1, 2007
Brock M Malcolm Individual Corporate OfficerCoo Aug 1, 2007
Patricia Louise Collett Individual Corporate OfficerDirector of Medical Services Nov 18, 2000
Thelma J Samples Individual Corporate DirectorBoard Member Apr 1, 2011
Gregory H Moore Individual Corporate DirectorBoard Member Oct 15, 2013
Travis M Miller Individual Corporate DirectorBoard Member Apr 1, 2011

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
West Virginia Wesleyan College Wellness CenterBuckhannon, WV, CCN 511146 Federally qualified health center Operational/Managerial Control (100%) May 21, 2018

Practitioners & affiliated clinicians

Practitioners 105

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 105

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344211200000",
    "number": "1689921082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 305",
            "city": "FRENCH CREEK",
            "state": "WV",
            "postal_code": "262189667",
            "telephone_number": "304-924-6381",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 305",
            "city": "FRENCH CREEK",
            "state": "WV",
            "postal_code": "262189667",
            "telephone_number": "304-924-6381",
            "fax_number": "304-924-5460"
        }
    ],
    "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": "2012-08-06",
        "last_updated": "2012-08-06",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-924-6262"
    },
    "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": "French Creek Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in French Creek, WV

Sources for this page

Verify at the official NPI Registry.