NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

Doing business as Community Care of Flatwoods

  • Federally Qualified Health Center (FQHC)
  • Sutton, WV
National Provider Identifier
1770917577
Registry record updated Jan 19, 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 Flatwoods
Practice address
266 Skidmore LN
Sutton, WV 26601-9271
Phone
(394) 765-0351
Fax
(304) 765-7019
NPI assigned
Aug 28, 2013
Last updated
Jan 19, 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 Jan 19, 2024

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

Authorized official

Name
Dora L Potasnik
Title
Credentialing
Phone
(304) 317-7275

Specialties & licenses 1

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

Addresses

Primary practice location

266 Skidmore LN
Sutton, WV 26601-9271

Mailing address

266 Skidmore LN
Sutton, WV 26601-9271
Phone (394) 765-0351

Other names 1

  • Community Care of Flatwoods Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131031000746 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Sutton, WV
O20131219001230 WV Part B Supplier - Clinic/Group Practice 0446232987 Receives reassigned benefits from 60 practitioners
Practice locations: Sutton, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770917577. Details of each certification follow.

Federally qualified health center certification: CCN 511024

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
COMMUNITY CARE OF FLATWOODS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2013
Last certification
Oct 31, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
266 Skidmore LN
Sutton, WV 26601-9271

National Provider Directory

National Provider Directory
Part of
Community Care of West Virginia

Ownership & related parties

All disclosed owners & managing parties 18

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 Jan 9, 2012
Kristi Walkr Individual Corporate OfficerCoo Oct 15, 2022
Juston Chad Morrison Individual Corporate Director Apr 10, 2017
Hillary Nicole Tenney Individual W-2 Managing EmployeeCredentialing Coordinator Aug 1, 2019
Elisabeth M Samples Individual Corporate DirectorBoard Secretary Jan 1, 2018
Michele Williams Individual Corporate OfficerCompliance Officer Dec 12, 2005
Jeffrey Jenkins Individual Corporate OfficerCfo Apr 4, 2022
Richard G Simon Individual Corporate OfficerCeo Sep 13, 1993 100%
David B Malcomb Individual Corporate Director Jan 1, 2018
Selah Raines Individual Corporate Director Jan 1, 2020
David D Taylor Individual Corporate Director Mar 14, 2016
Katherine Anne Horner Individual Corporate DirectorBoard Vice- President Jan 14, 2019
Kimberly Renee Becher Individual Corporate OfficerChief Medical Officer Sep 23, 2021
Patricia Louise Collett Individual Corporate OfficerDeputy Ceo Nov 18, 2000
Steven Roy Flaughers Individual Corporate Director Jan 14, 2019
Rosemary M Thomas Individual Corporate Director Jan 1, 2020
James L Estep Individual Corporate DirectorBoard Treasurer Jan 1, 2020
Sarina Smith Individual Corporate Director Jan 14, 2019

Owners & managing parties with NPI records 2

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 60

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 60

NPI Registry JSON

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1770917577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 SKIDMORE LN",
            "city": "SUTTON",
            "state": "WV",
            "postal_code": "266019271",
            "telephone_number": "394-765-0351",
            "fax_number": "304-765-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 SKIDMORE LN",
            "city": "SUTTON",
            "state": "WV",
            "postal_code": "266019271",
            "telephone_number": "394-765-0351",
            "fax_number": "304-765-7019"
        }
    ],
    "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": "2013-08-28",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-317-7275"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care of Flatwoods",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Care of Flatwoods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sutton, WV

Sources for this page

Verify at the official NPI Registry.