NPIMap

Organization Active NPI

Wirt County Health Services Association, Inc

Doing business as Parkersburg Family Care

  • Federally Qualified Health Center (FQHC)
  • Parkersburg, WV
National Provider Identifier
1760733984
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
Parkersburg Family Care
Practice address
2610 Camden Ave
Parkersburg, WV 26101-5652
Phone
(304) 917-3733
Fax
(304) 917-3750
NPI assigned
Sep 27, 2012
Last updated
Mar 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Authorized official

Name
Mrs. Vicki L Knicely
Title
Billing/Credentialing Supervisor
Phone
(304) 275-3301

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

2610 Camden Ave
Parkersburg, WV 26101-5652

Mailing address

2610 Camden Ave
Parkersburg, WV 26101-5652
Phone (304) 917-3733

Other identifiers 1

IdentifierTypeStateIssuer
0009486002MedicaidWV

Other names 1

  • Parkersburg Family Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131105001348 WV Part A Provider - Federally Qualified Health Center (FQHC) 7810806577 Practice locations: Parkersburg, WV
O20140317001851 WV Part B Supplier - Clinic/Group Practice 7810806577 Receives reassigned benefits from 36 practitioners
1 other NPI on this enrollment
Practice locations: Elizabeth, WV; Parkersburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760733984. Details of each certification follow.

Federally qualified health center certification: CCN 511026

Legal name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
PARKERSBURG FAMILY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 5, 2013
Last certification
Nov 5, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 1978 in WV
Enrollment address
2610 Camden Ave
Parkersburg, WV 26101-5652

Other NPIs with the same Medicare PAC ID 10

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

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Donald Brookover Individual Other Jul 1, 1978
Treva Full Individual Other Feb 1, 2010
Julie a Stanley Individual Corporate OfficerCfo Oct 1, 2018
W-2 Managing EmployeeCfo Oct 1, 2018
Berkley Simmons Individual Other Dec 1, 2014
James Frazier Individual Other Aug 1, 2011
Melissa Weekley Individual Other Jul 1, 2013
David M Schenkelberg Individual Other Aug 1, 2013
Judy Cline Individual Other Jul 1, 2000
Vicki Knicely Individual Corporate OfficerOffice Manager Mar 1, 2002
W-2 Managing EmployeeDelegated Official Mar 1, 2002
Douglas Full Individual Other Jul 1, 2013
Anessa Dille Individual W-2 Managing EmployeeBilling Clerk & Credentialing Su Jul 1, 2014

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 2

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

FacilityTypeRoleSince
Ripley Family MedicineRipley, WV, CCN 511933 Federally qualified health center Operational/Managerial Control Jul 17, 1978
Wirt County Health Services Association, IncParkersburg, WV, CCN 581818 Federally qualified health center Operational/Managerial Control Oct 13, 2021

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1760733984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 CAMDEN AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261015652",
            "telephone_number": "304-917-3733",
            "fax_number": "304-917-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 CAMDEN AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261015652",
            "telephone_number": "304-917-3733",
            "fax_number": "304-917-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-27",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "KNICELY",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "304-275-3301",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009486002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkersburg Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Parkersburg, WV

Sources for this page

Verify at the official NPI Registry.