Community Care of West Virginia, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Sutton, WV
NPI 1750892188 · NPPES record last updated Oct 12, 2017
Key facts
- NPI
- 1750892188
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Practice address
- 288 N Hill Rd
Sutton, WV 26601-1225 - Phone
- (304) 924-6262
- Fax
- (304) 924-5460
- NPI assigned
- Oct 12, 2017
- Organization subpart
- No
Authorized official
- Name
- Dora L Potasnik
- Title
- Credentialing Coordinator
- Phone
- (304) 587-2541
Owners & managing parties with NPI records 2
-
Patricia L Collett, PA-C
Corporate family (same tax ID) 18
Practitioners 114
-
Joshua Scott Abbott, DDS
-
Laura Evelyn Abbott, DDS
-
Betsy Coulter, LICSW
-
Stephanie Hope Jackson, APRN, FNP-BC
-
Megan Lynnette Parker, LGSW
-
Heather Anne Radcliffe, LICSW ACSW
-
Jennifer Abel, FNP-C
-
Allyson Malone Andrews, PA-C
-
Joshua Steven Baker, PAC
-
Nicholas Joel Baker, PA-C
-
Barbara Ballash, LICENSED PSYCHOLOGIS
-
Sean R. Barnett, PA-C
-
Sarah Bell, DNP
-
Paula Blount, PA
-
Tracie F Bonner, FNP
-
Cheryl Ann Bowers, PA-C
-
Brandi Carpenter, FNP-C
-
Angela Gayle Carter, APRN, BC
-
Rachel Ann Clemens, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511137
- Legal name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Doing business as
- SUTTON ELEMENTARY SCHOOL WELLNESS CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 29, 2017
- Last certification
- Nov 29, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 1984 in WV
- Enrollment address
- 288 N Hill Rd
Sutton, WV 26601-1225
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Sarah Chouinard |
Corporate Officer |
Sep 2, 2003 | |
| Dora L. Potasnik |
W-2 Managing Employee |
Jan 9, 2012 | |
| Karen E Grant |
Corporate Director |
Apr 1, 2011 | |
| Thomas G Lynch |
Corporate Director |
Jul 1, 2007 | |
| Michele Williams |
Corporate Director |
Dec 12, 2005 | |
| Richard G Simon |
Corporate Officer |
Sep 13, 1992 | 100% |
| Connie a Johnston |
Corporate Director |
Mar 1, 2014 | |
| David D Taylor |
Corporate Director |
Mar 14, 2016 | |
| Renee a Hofer |
Corporate Director |
Jul 1, 2007 | |
| Brock M Malcolm |
Corporate Officer |
Aug 1, 2007 | |
| Patricia Louise Collett |
Corporate Director |
Nov 18, 2000 | |
| Thelma J Samples |
Corporate Director |
Apr 1, 2011 | |
| Gregory H Moore |
Corporate Director |
Oct 15, 2013 | |
| Travis M Miller |
Corporate Director |
Jul 1, 2007 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| West Virginia Wesleyan College Wellness Center |
Federally qualified health center | Operational/Managerial Control (100%) | May 21, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180111002647 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 0446232987 | Practice locations: Sutton, WV |
| O20180423000929 | WV | Part B Supplier - Clinic/Group Practice | 0446232987 |
Receives reassigned benefits from 6 practitioners Practice locations: Sutton, WV |
National Provider Directory
- Tax ID family
- Leading Creek Elem
Locations
288 N Hill Rd
Sutton, WV 26601
Phone (304) 402-2105
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
288 N Hill Rd
Sutton, WV 26601-1225
Mailing address
288 N Hill Rd
Sutton, WV 26601-1225
Phone (304) 924-6262
Other names
- Sutton Elementary School Wellness Center
Other providers in Sutton, WV
- Sonja L Collins
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Community Care of West Virginia, Inc.
- Melinda Conn
- Brittany Leann Conner
- Lora Conner
All providers in Sutton, 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 Oct 12, 2017. 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.