NPIMap

Organization Active NPI

Williamson Health & Wellness Center Inc

Doing business as Williamson Health & Wellness Center - Alderson Clinic

  • Federally Qualified Health Center (FQHC)
  • Williamson, WV
National Provider Identifier
1700445798
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Doing business as
Williamson Health & Wellness Center - Alderson Clinic
Practice address
859 Alderson St Ste 1000
Williamson, WV 25661-3215
Phone
(304) 236-5902
Fax
(855) 487-4047
NPI assigned
Jun 12, 2019
Last updated
May 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAMSON HEALTH & WELLNESS CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Authorized official

Name
Christopher Donovan Beckett
Title
Ceo
Phone
(304) 236-5902

Specialties & licenses 1

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

Addresses

Primary practice location

859 Alderson St Ste 1000
Williamson, WV 25661-3215

Mailing address

PO Box 2080
Williamson, WV 25661-2080
Phone (304) 236-5902

Other names 1

  • Williamson Health & Wellness Center - Alderson Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140521000620 WV Part B Supplier - Clinic/Group Practice 5395972996 Receives reassigned benefits from 31 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williamson, WV; Lavalette, WV; Matewan, WV; Delbarton, WV
O20200114002141 WV Part A Provider - Federally Qualified Health Center (FQHC) 5395972996 1 other NPI on this enrollment
Practice locations: Williamson, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700445798. Details of each certification follow.

Federally qualified health center certification: CCN 511177

Legal name
WILLIAMSON HEALTH & WELLNESS CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2019
Last certification
Nov 22, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2014 in WV
Enrollment address
859 Alderson St
Ste 1000
Williamson, WV 25661

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Williamson Health Wellness Center Inc18 organizations share this tax ID, including this one
Part of
Williamson Health Wellness Center Inc

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

859 Alderson St
#1000
Williamson, WV 25661

183 E 2nd Ave
Williamson, WV 25661
Phone (304) 235-2930

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Christopher Donovan Beckett Individual 5% Or Greater Direct Ownership InterestManagerial Dec 1, 2019 100%
Corporate OfficerCeo Dec 1, 2019 100%
Operational/Managerial ControlCeo Dec 1, 2019
David Jewell Individual Corporate DirectorCfo Jun 1, 2020

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Williamson Health & Wellness Center- Behavioral Medicine ClinicWilliamson, WV, CCN 510094 Hospital 5% Or Greater Direct Ownership Interest (100%) May 31, 2020
Williamson Health & Wellness Center IncWilliamson, WV, CCN 511032 Federally qualified health center Operational/Managerial Control Sep 3, 2013
Williamson Health & Wellness Center-Matewan PK-8Matewan, WV, CCN 581078 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1700445798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2080",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256612080",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 ALDERSON ST STE 1000",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613215",
            "telephone_number": "304-236-5902",
            "fax_number": "855-487-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSON HEALTH & WELLNESS CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAMSON HEALTH & WELLNESS CENTER INC",
        "enumeration_date": "2019-06-12",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "DONOVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-236-5902"
    },
    "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": "Williamson Health & Wellness Center - Alderson Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamson, WV

Sources for this page

Verify at the official NPI Registry.