NPIMap

Organization Active NPI

Western North Carolina Community Health Services Inc.

  • Federally Qualified Health Center (FQHC)
  • Asheville, NC
National Provider Identifier
1780801050
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES INC.
Practice address
257 Biltmore Ave
Asheville, NC 28801-4120
Phone
(828) 285-0622
Fax
(828) 285-9421
NPI assigned
Apr 19, 2007
Last updated
Mar 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Authorized official

Name
Carlos Gomez
Title
Chief Executive Officer
Phone
(828) 285-0622

Specialties & licenses 1

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

Addresses

Primary practice location

257 Biltmore Ave
Asheville, NC 28801-4120

Mailing address

257 Biltmore Ave
Asheville, NC 28801-4120
Phone (828) 285-0622

Other identifiers 1

IdentifierTypeStateIssuer
344583AMedicaidNC

Other names 1

  • WESTERN NORTH CAROLINA COMM HLT Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040825001424 NC Part B Supplier - Clinic/Group Practice 0840264669 Receives reassigned benefits from 56 practitioners
1 other NPI on this enrollment
Practice locations: Asheville, NC
O20071220000713 NC Part A Provider - Federally Qualified Health Center (FQHC) 0840264669 Practice locations: Asheville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780801050. Details of each certification follow.

Federally qualified health center certification: CCN 341866

Legal name
WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2002
Last certification
Apr 2, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1993 in NC
Enrollment address
257 Biltmore Ave
Asheville, NC 28801-4120

Other NPIs with the same Medicare PAC ID 2

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 9

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

NameRoleSinceShare
Aviva E Bruyer Individual Corporate DirectorBoard Member Jan 1, 2012
Nicole Ramos Individual Corporate DirectorBoard Secretary Jan 1, 2017
James R Lester Individual Corporate DirectorBoard Member Jan 1, 2013
Kim a Wagenaar Individual Corporate OfficerCeo Jun 24, 2019 100%
W-2 Managing EmployeeCeo Jun 24, 2019 100%
Operational/Managerial ControlCeo Jun 24, 2019 100%
Dolores H Deese Individual Corporate DirectorBoard Member Jan 1, 2015
Margarita Maestri Individual Corporate DirectorBoard Member Jan 1, 2012
Raymond L Edwards Individual Corporate DirectorBoard Member Jan 1, 2016
Charles M Boyd Individual Corporate DirectorBoard Member Jan 1, 2012
Thomas Van Blaricom Individual Corporate DirectorBoard Member Jan 1, 2007

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1780801050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 BILTMORE AVE",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288014120",
            "telephone_number": "828-285-0622",
            "fax_number": "828-285-9421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 BILTMORE AVE",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288014120",
            "telephone_number": "828-285-0622",
            "fax_number": "828-285-9421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "828-285-0622"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344583A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WESTERN NORTH CAROLINA COMM HLT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Asheville, NC

Sources for this page

Verify at the official NPI Registry.