Clay-Battelle Health Services Association
Organization Active NPI Federally Qualified Health Center (FQHC) · Blacksville, WV
NPI 1699830752 · NPPES record last updated Aug 25, 2021
Key facts
- NPI
- 1699830752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
- Practice address
- 5861 Mason Dixon Hwy
Blacksville, WV 26521 - Phone
- (304) 432-8211
- Fax
- (304) 432-8213
- NPI assigned
- Dec 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Rebecca J Thomas
- Title
- Ceo
- Phone
- (304) 432-8211
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 8
-
Shawna Cogar, LGSW
-
Megan Moore Curry, PA-C
-
Larry R Gitelman, ADVANCED RN PRACT
-
Andrea Marie Hoekje, PA-C
-
Aaron Hoekje, PA-C
-
Wade Vincent Harvey, M.D.
-
Richard A Spencer, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511833
- Legal name
- CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
- Doing business as
- CLAY-BATTELLE COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 11, 1992
- Last certification
- Aug 11, 1992
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 1, 1972 in WV
- Enrollment address
- 5861 Mason Dixon Hwy
Blacksville, WV 26521-8300
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Rodney a Clovis |
Corporate Officer |
Jul 1, 2011 | |
| Corporate Director |
Jul 1, 2011 | ||
| Johanna Lemasters |
Corporate Director |
Oct 15, 2024 | |
| David Cottrell |
Corporate Officer |
Oct 1, 2023 | |
| Corporate Director |
May 18, 2021 | ||
| David L Pethtel |
Corporate Officer |
Apr 1, 2011 | |
| Corporate Director |
Jul 1, 2011 | ||
| Andrew Hutson |
Corporate Director |
Jul 19, 2022 | |
| Charles Barnhart |
Corporate Director |
Jun 1, 2013 | |
| Joseph Statler |
Corporate Director |
Jan 1, 2024 | |
| Tabatha Layton |
Corporate Director |
Jul 19, 2022 | |
| Rita C Roberts |
Corporate Director |
Jul 1, 2011 | |
| Rebecca J Thomas |
Corporate Officer |
Jan 1, 2019 | |
| W-2 Managing Employee |
Jan 1, 2019 | ||
| Operational/Managerial Control |
Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040121000993 | WV | Part B Supplier - Clinic/Group Practice | 3870495815 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Blacksville, WV; Burton, WV |
| O20100908000006 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 3870495815 |
1 other NPI on this enrollment Practice locations: Blacksville, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
5861 Mason Dixon Hwy
Blacksville, WV 26521
Mailing address
PO Box 72
Blacksville, WV 26521-0072
Phone (304) 432-8211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0035288000 | Medicaid | WV | |
| CN0274 | Other | RAILROAD MEDICARE | |
| CN0274 | Other | WV | RR MC |
| 001709531 | Other | WV | MS BCBS |
Other names
- Clay-Battelle Community Health Center
Other providers in Blacksville, WV
- Mackenzie Christine Chase
- Clay-Battelle Health Services Association
- Clay-Battelle Health Services Association
- Community Care of West Virginia Inc
- Megan Moore Curry
- Seneca Abbie Field
- Wade Vincent Harvey
All providers in Blacksville, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.