NPIMap

Organization Active NPI

New River Health Association, Inc

Doing business as New River Intermediate School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Oak Hill, WV
National Provider Identifier
1740417401
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1036-9138 Issued in WV
Legal business name
NEW RIVER HEALTH ASSOCIATION, INC
Doing business as
New River Intermediate School Based Health Center
Practice address
262 Oyler Avenue
Oak Hill, WV 25901-2639
Phone
(304) 465-2171
Fax
(304) 465-2173
NPI assigned
Jun 19, 2009
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
NEW RIVER HEALTH ASSOCIATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Marissa Johnson
Title
Credentialing Officer
Phone
(304) 469-2905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1036-9138 WV Primary

Addresses

Primary practice location

262 Oyler Avenue
Oak Hill, WV 25901-2639

Mailing address

497 Mall Rd
Oak Hill, WV 25901-6216

Other identifiers 2

IdentifierTypeStateIssuer
0035165000MedicaidWV
3810020556MedicaidWV

Other names 1

  • New River Intermediate School Based Health 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
O20071009000136 WV Part B Supplier - Public Health/Welfare Agency 2365348596 Receives reassigned benefits from 21 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coal City, WV; Lookout, WV; Oak Hill, WV; Sophia, WV; Summersville, WV
O20110202000723 WV Part A Provider - Federally Qualified Health Center (FQHC) 2365348596 Practice locations: Oak Hill, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740417401. Details of each certification follow.

Federally qualified health center certification: CCN 511963

Legal name
NEW RIVER HEALTH ASSOCIATION INC
Doing business as
NEW RIVER INTERMEDIATE SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 4, 2011
Last certification
Feb 4, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 27, 1976 in WV
Enrollment address
262 Oyler Avenue
Oak Hill, WV 25901-2639

Other NPIs with the same Medicare PAC ID 21

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

View all 21

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
Part of
New River Family HLTH C

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Joe Brouse Individual Other Apr 1, 2016
Angela M Barker Individual Corporate Officer Feb 1, 2014
Sharon Bradley Individual Other May 1, 2015
Nathan Hollister Individual Other Jan 1, 2020
Marissa Johnson Individual W-2 Managing Employee Jan 7, 2019
New River Health Association Inc Organization, Scarbro, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 27, 1976 100%
Erin Reid Individual Other Jan 1, 2020
Robert Simmons Individual Corporate OfficerBoard Member Jul 1, 2006
Corporate Director Dec 1, 2010
Dustin White Individual Corporate Officer Sep 1, 2015
Paul Lively Individual Corporate OfficerBoard Member Jun 13, 2008
Corporate Director Dec 2, 2010
Rose Michaels Individual Other Nov 1, 2014
Gabriel Pena Individual Other Nov 11, 2013
John R Schultz Individual Corporate DirectorExe Dir Jan 7, 2013
W-2 Managing EmployeeExe Dir Jan 7, 2013
Evelyn Hizer Individual Corporate OfficerBoard Member Jul 1, 1995
Corporate Director Dec 1, 2010
Angela Sundstrom Individual Other Feb 1, 2016
Gary Hairston Individual Other Sep 1, 2012

Owners & managing parties with NPI records 22

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

View all 22

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
New River Health - SophiaSophia, WV, CCN 511956 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Oak Hill High School Based Health CenterOak Hill, WV, CCN 511962 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Nicholas County School Based Health CenterSummersville, WV, CCN 511965 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Coal City Elementary School Based Health CenterCoal City, WV, CCN 511969 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Independence School Based Health CenterCoal City, WV, CCN 511970 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Health - SummersvilleSummersville, WV, CCN 511124 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 1, 2017
Independence Middle School Based Health CenterCoal City, WV, CCN 511161 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 26, 2018
Jun 26, 2018
Fayetteville PK-8 School Based Health CenterFayetteville, WV, CCN 511179 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - SmithersSmithers, WV, CCN 511189 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - Oak HillOak Hill, WV, CCN 581809 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976

Owned or controlled facilities with NPI records 11

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

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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": "1245369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1740417401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 MALL RD",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259016216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 OYLER AVENUE",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259012639",
            "telephone_number": "304-465-2171",
            "fax_number": "304-465-2173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER HEALTH ASSOCIATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "enumeration_date": "2009-06-19",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "304-469-2905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "1036-9138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035165000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810020556",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New River Intermediate School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Hill, WV

Sources for this page

Verify at the official NPI Registry.