NPIMap

Organization Active NPI

St. Charles Health Counsel, Inc.

Doing business as Stone Mountain Health Services

  • Federally Qualified Health Center (FQHC)
  • Jonesville, VA
National Provider Identifier
1740252501
Registry record updated Jul 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST. CHARLES HEALTH COUNSEL, INC.
Doing business as
Stone Mountain Health Services
Practice address
276 Fieldstone Drive
Jonesville, VA 24263-1215
Phone
(276) 546-5310
Fax
(276) 546-5469
NPI assigned
Feb 6, 2006
Last updated
Jul 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2019

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

Authorized official

Name
Mr. Malcolm Perdue
Title
Ceo
Phone
(276) 546-5310

Specialties & licenses 1

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

Addresses

Primary practice location

276 Fieldstone Drive
Jonesville, VA 24263-1215

Mailing address

276 Fieldstone Drive
Jonesville, VA 24263-1215
Phone (276) 546-5310

Other names 1

  • Stone Mountain Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060720000152 VA Part A Provider - Federally Qualified Health Center (FQHC) 0244124584 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Appalachia, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740252501. Details of each certification follow.

Federally qualified health center certification: CCN 491867

Legal name
ST. CHARLES HEALTH COUNCIL INC
Doing business as
STONE MOUNTAIN HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 5, 2006
Last certification
Oct 5, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Aug 9, 1973 in VA
Enrollment address
536 E Main St
Appalachia, VA 24216-1500

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
St Charles Health Council Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Betty Rose Individual Corporate DirectorBoard Member Jun 1, 2021
Rufus C Hay Individual Corporate Director Jul 1, 2006
Joyce Williams Individual Corporate DirectorBoard Member Jun 1, 2021
Malcolm L Perdue Individual Corporate DirectorPresident/Ceo Jul 1, 2006 100%
Violet J Martin Individual Corporate Director Jul 1, 2006
Nancy S Gibson Individual Corporate DirectorBoard Member Jun 1, 2021
Douglas McConnell Individual Corporate DirectorBoard Member Jun 1, 2021
Homer Wayne Fields Individual Corporate DirectorBoard Member Jun 1, 2021
Rebecca Johnson Individual Corporate DirectorBoard Member Jun 1, 2021
Mary K Edwards Individual Corporate Director Jul 1, 2006
Saundra Jones Individual W-2 Managing Employee Jul 1, 2006
Nancy Mann Individual Corporate DirectorBoard Member Jun 1, 2021
Janice Harber Individual Corporate DirectorBoard Member Jun 1, 2021
Sherry Lowe Individual Corporate DirectorBoard Member Jun 1, 2021
Delores Anne Pennington Individual Corporate DirectorBoard Member Jun 1, 2021
Gregory D Edwards Individual Corporate Director Jul 1, 2006
Deborah Bostic Individual Corporate DirectorBoard Member Jun 1, 2021
James Oquinn Individual Corporate DirectorBoard Member Jun 1, 2021
Kathy Turner Individual Corporate DirectorBoard Member Jun 1, 2021
Gary Bush Individual Corporate DirectorBoard Member Jun 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1740252501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 FIELDSTONE DRIVE",
            "city": "JONESVILLE",
            "state": "VA",
            "postal_code": "242631215",
            "telephone_number": "276-546-5310",
            "fax_number": "276-546-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 FIELDSTONE DRIVE",
            "city": "JONESVILLE",
            "state": "VA",
            "postal_code": "242631215",
            "telephone_number": "276-546-5310",
            "fax_number": "276-546-5469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES HEALTH COUNSEL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "PERDUE",
        "authorized_official_first_name": "MALCOLM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "276-546-5310",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "Stone Mountain Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stone Mountain Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesville, VA

Sources for this page

Verify at the official NPI Registry.