Community Care of West Virginia, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Sutton, WV
NPI 1770917577 · NPPES record last updated Jan 19, 2024
Key facts
- NPI
- 1770917577
- 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
- 266 Skidmore LN
Sutton, WV 26601-9271 - Phone
- (394) 765-0351
- Fax
- (304) 765-7019
- NPI assigned
- Aug 28, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
- Name
- Dora L Potasnik
- Title
- Credentialing
- Phone
- (304) 317-7275
Owners & managing parties with NPI records 2
-
Patricia L Collett, PA-C
Practitioners 60
-
Jennifer Abel, FNP-C
-
Nicholas Joel Baker, PA-C
-
Sarah Bell, DNP
-
Brandi Carpenter, FNP-C
-
Angela Gayle Carter, APRN, BC
-
Patricia L Collett, PA-C
-
Diana Lynn Cooper, FNP-C
-
Betsy Coulter, LICSW
-
Penny N Cutlip, FNP
-
Melissa S Dodrill, M.D.
-
Kelly W Dunavant, DO
-
Katherine Flint, APRN, FNP-C
-
Lesley Groves, N.P.
-
Ashley Renee Hart, FNP
-
Frances Lilly Heater, APRN -CNP
-
Kevin S Ivory, PA-C
-
Leigh Anne Jackson, FNP-BC
-
Stephanie Hope Jackson, APRN, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
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
- Corporation · Non-profit
- Incorporated
- Jul 1, 1984 in WV
- Enrollment address
- 266 Skidmore LN
Sutton, WV 26601-9271
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Dora L. Potasnik |
W-2 Managing Employee |
Jan 9, 2012 | |
| Kristi Walkr |
Corporate Officer |
Oct 15, 2022 | |
| Juston Chad Morrison |
Corporate Director | Apr 10, 2017 | |
| Hillary Nicole Tenney |
W-2 Managing Employee |
Aug 1, 2019 | |
| Elisabeth M Samples |
Corporate Director |
Jan 1, 2018 | |
| Michele Williams |
Corporate Officer |
Dec 12, 2005 | |
| Jeffrey Jenkins |
Corporate Officer |
Apr 4, 2022 | |
| Richard G Simon |
Corporate Officer |
Sep 13, 1993 | 100% |
| David B Malcomb |
Corporate Director | Jan 1, 2018 | |
| Selah Raines |
Corporate Director | Jan 1, 2020 | |
| David D Taylor |
Corporate Director | Mar 14, 2016 | |
| Katherine Anne Horner |
Corporate Director |
Jan 14, 2019 | |
| Kimberly Renee Becher |
Corporate Officer |
Sep 23, 2021 | |
| Patricia Louise Collett |
Corporate Officer |
Nov 18, 2000 | |
| Steven Roy Flaughers |
Corporate Director | Jan 14, 2019 | |
| Rosemary M Thomas |
Corporate Director | Jan 1, 2020 | |
| James L Estep |
Corporate Director |
Jan 1, 2020 | |
| Sarina Smith |
Corporate Director | Jan 14, 2019 |
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 |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Leading Creek Elem
Locations
266 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-0351
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Community Care of Flatwoods
Other providers in Sutton, WV
- 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
- Allison Conrad
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 Jan 19, 2024. 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.