NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

Doing business as Community Care of Helvetia

  • Federally Qualified Health Center (FQHC)
  • Helvetia, WV
National Provider Identifier
1740310663
Registry record updated Feb 13, 2024
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
Community Care of Helvetia
Practice address
100 S. Pickens Rd
Helvetia, WV 26224-0027
Phone
(304) 924-6262
Fax
(304) 924-5460
NPI assigned
Mar 7, 2007
Last updated
Feb 13, 2024By 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 Feb 13, 2024

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

Authorized official

Name
Ms. Dora L Potasnik
Title
Credentialing Coordinator
Phone
(304) 924-6262

Specialties & licenses 1

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

Addresses

Primary practice location

100 S. Pickens Rd
Helvetia, WV 26224-0027

Mailing address

PO Box 217
Rock Cave, WV 26234-0217
Phone (304) 924-6262

Other identifiers 1

IdentifierTypeStateIssuer
0035420000MedicaidWV

Other names 1

  • Community Care of Helvetia Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070907000780 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Receives reassigned benefits from 1 practitioner
Practice locations: Helvetia, WV
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740310663. Details of each certification follow.

Federally qualified health center certification: CCN 511868

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
COMMUNITY CARE OF HELVETIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 14, 1998
Last certification
Oct 14, 1998
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
100S Pickens Rd
Helvetia, WV 26224

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
Primary Care Systems Inc

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Dora L. Potasnik Individual W-2 Managing EmployeeCredentialing Coordinator Jan 9, 2012
Kristi Walkr Individual Corporate OfficerCoo Oct 15, 2022
Juston Chad Morrison Individual Corporate DirectorBoard Member Apr 10, 2017
Elisabeth M Samples Individual Corporate DirectorBoard Member Jan 1, 2018
Michele Williams Individual Corporate OfficerCompliance Officer Dec 12, 2005
Jeffrey Jenkins Individual Corporate OfficerCfo Apr 4, 2022
David B Malcomb Individual Corporate DirectorBoard Member Jan 1, 2018
Selah Raines Individual Corporate DirectorBoard Member Jan 1, 2020
David D Taylor Individual Corporate DirectorBoard Member Mar 14, 2016
Abigail Friend Individual W-2 Managing EmployeeCredentialing Coordinator Aug 1, 2023
Katherine Anne Horner Individual Corporate DirectorBoard Member Jan 14, 2019
Kimberly Renee Becher Individual Corporate OfficerCmo Sep 23, 2021
Patricia Louise Collett Individual Corporate OfficerCeo Nov 18, 2000 100%
Steven Roy Flaughers Individual Corporate DirectorBoard Member Jan 14, 2019
Shelly Gause Individual W-2 Managing EmployeeCredentialing Coordinator Jan 28, 2023
Rosemary M Thomas Individual Corporate OfficerBoard President Jan 1, 2020
James L Estep Individual Corporate DirectorBoard Treasurer Jan 1, 2020
Sarina Smith Individual Corporate DirectorBoard Member Jan 14, 2019
Kevin Douglas Junkins Individual Corporate OfficerBH-Cmo Jun 9, 2017

Owners & managing parties with NPI records 3

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 113

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 113

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1740310663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S. PICKENS RD",
            "city": "HELVETIA",
            "state": "WV",
            "postal_code": "262240027",
            "telephone_number": "304-924-6262",
            "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": "2007-03-07",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "304-924-6262",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035420000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care of Helvetia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Helvetia, WV

Sources for this page

Verify at the official NPI Registry.