NPIMap

Organization Active NPI

Community Care of West Virginia, Inc.

Doing business as Marlinton Elementary School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Marlinton, WV
National Provider Identifier
1790033082
Registry record updated Aug 17, 2012
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
Marlinton Elementary School Wellness Center
Practice address
926A 5TH Ave
Marlinton, WV 24954-1209
Phone
(304) 799-6551
Fax
(304) 799-6552
NPI assigned
Aug 17, 2012
Last updated
Aug 17, 2012By 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 Aug 17, 2012

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

Authorized official

Name
Richard G Simon
Title
Ceo
Phone
(304) 924-6262

Specialties & licenses 1

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

Addresses

Primary practice location

926A 5TH Ave
Marlinton, WV 24954-1209

Mailing address

926A 5TH Ave
Marlinton, WV 24954-1209
Phone (304) 799-6551

Other names 1

  • Marlinton Elementary School Wellness Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071024000166 WV Part B Supplier - Public Health/Welfare Agency 0446232987 Receives reassigned benefits from 74 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clay, WV; Buckhannon, WV; West Milford, WV; Rock Cave, WV; Marlinton, WV; Ivydale, WV; Helvetia, WV; Green Bank, WV…
O20121012000674 WV Part A Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Marlinton, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790033082. Details of each certification follow.

Federally qualified health center certification: CCN 511000

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
MARLINTON ELEMENTARY SCHOOL WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 15, 2012
Last certification
Oct 15, 2012
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
926 A 5TH Ave
Marlinton, WV 24954-1209

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Part of
Tri County Health Clinic Inc

Locations

926 5th Ave
Ste A
Marlinton, WV 24954
Phone (304) 799-4916

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Sarah Chouinard Individual Corporate OfficerCmo Sep 1, 2003
Dora L. Potasnik Individual W-2 Managing EmployeeCredentialing Jan 9, 2012
Juston Chad Morrison Individual Corporate Director Apr 10, 2017
Hillary Nicole Tenney Individual W-2 Managing EmployeeCredentialing Coordinator Aug 1, 2022
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 Director Jan 14, 2019
Patricia Louise Collett Individual Corporate OfficerCoo Nov 18, 2000
Steven Roy Flaughers Individual Corporate Director Jan 14, 2019
Rosemary M Thomas Individual Corporate DirectorBoard President 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 101

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 101

NPI Registry JSON

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345161600000",
    "number": "1790033082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926A 5TH AVE",
            "city": "MARLINTON",
            "state": "WV",
            "postal_code": "249541209",
            "telephone_number": "304-799-6551",
            "fax_number": "304-799-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926A 5TH AVE",
            "city": "MARLINTON",
            "state": "WV",
            "postal_code": "249541209",
            "telephone_number": "304-799-6551",
            "fax_number": "304-799-6552"
        }
    ],
    "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": "2012-08-17",
        "last_updated": "2012-08-17",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-924-6262"
    },
    "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": "Marlinton Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marlinton, WV

Sources for this page

Verify at the official NPI Registry.