NPIMap

Organization Active NPI

Central Virginia Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Petersburg, VA
National Provider Identifier
1801411202
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL VIRGINIA HEALTH SERVICES INC
Practice address
3101 Johnson Rd
Petersburg, VA 23805-2338
Phone
(804) 861-4884
NPI assigned
Jun 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Authorized official

Name
Charles Allbaugh
Title
Cfo
Phone
(434) 581-3271

Specialties & licenses 1

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

Addresses

Primary practice location

3101 Johnson Rd
Petersburg, VA 23805-2338

Mailing address

PO Box 220
New Canton, VA 23123-0220
Phone (434) 581-4073

Other names 1

  • CVHS Crimson Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201022004186 VA Part A Provider - Federally Qualified Health Center (FQHC) 0345158432 Practice locations: Petersburg, VA

Federally qualified health center certification: CCN 491972

Legal name
CENTRAL VIRGINIA HEALTH SERVICES INC
Doing business as
CVHS CRIMSON CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2020
Last certification
Oct 22, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 1970 in VA
Enrollment address
3101 Johnson Rd
Petersburg, VA 23805-2338

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2191864CVHS Crimson Clinic3101 Johnson Rd, Petersburg, VA 23805Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Central VA Health Servi24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

3101 Johnson Rd
Petersburg, VA 23805
Phone (804) 861-4884

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Tamica Williams Individual Corporate DirectorBoard Member Dec 1, 2014
Samuel Bateman Individual Corporate DirectorBoard Secretary Mar 21, 2003
Randall Thomas Bashore Individual W-2 Managing EmployeeMedical Director Jul 8, 1985
Rosario-Ninel E Foss Individual Corporate DirectorBoard Member Nov 1, 2016
Aracely Harris Individual Corporate DirectorBoard Member Feb 1, 2020
Evelyn Benet Individual Corporate DirectorBoard Member Oct 1, 2014
Marguerite Young Individual Corporate DirectorBoard Member Jan 1, 2009
Paula Tomko Individual Corporate OfficerCeo Jan 1, 2020
Corporate DirectorCeo Jan 1, 2020
W-2 Managing EmployeeCeo Jan 1, 2020
Byron Adkins Individual Corporate DirectorBoard Member Mar 21, 2003
Carolyn Perry Individual Corporate DirectorBoard Member Dec 1, 2014
Debra Jones Individual Corporate DirectorBoard Member Dec 1, 2014
Peggy Scott Individual Corporate DirectorBoard Member Feb 1, 1996
Charles Allbaugh Individual Corporate OfficerCfo Sep 18, 1995
W-2 Managing EmployeeCfo Sep 18, 1995
Jearline Taylor Individual Corporate DirectorBoard Member Jan 1, 2000
Frankie Sheridan Individual Corporate DirectorBoard President Mar 21, 2003
Robert C Smith Individual Corporate DirectorBoard Member Dec 1, 2007

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 1

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

FacilityTypeRoleSince
CVHS PetersonCharlottesville, VA, CCN 491958 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2017

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 94

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 94

NPI Registry JSON

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1801411202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "NEW CANTON",
            "state": "VA",
            "postal_code": "231230220",
            "telephone_number": "434-581-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 JOHNSON RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052338",
            "telephone_number": "804-861-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VIRGINIA HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "ALLBAUGH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "434-581-3271"
    },
    "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": "CVHS Crimson Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.