NPIMap

Organization Active NPI

Wirt County Health Services Association, Inc

Doing business as Parkersburg High School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Parkersburg, WV
National Provider Identifier
1811664378
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Doing business as
Parkersburg High School Wellness Center
Wirt County Health Services Association, Inc/Parkersburg Family Care D
Practice address
2101 Dudley Ave
Parkersburg, WV 26101-3462
Phone
(304) 917-3733
NPI assigned
Aug 24, 2021
Last updated
Aug 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Authorized official

Name
Brenda Bennett
Title
Credentialing
Phone
(304) 275-3301

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

2101 Dudley Ave
Parkersburg, WV 26101-3462

Mailing address

PO Box 609
Elizabeth, WV 26143-0609
Phone (304) 275-3301

Other names 2

  • Parkersburg High School Wellness Center Doing business as
  • Wirt County Health Services Association, Inc/Parkersburg Family Care D Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191021002731 WV Part B Supplier - Clinic/Group Practice 7810806577 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Parkersburg, WV
O20220209000378 WV Part A Provider - Federally Qualified Health Center (FQHC) 7810806577 Practice locations: Parkersburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811664378. Details of each certification follow.

Federally qualified health center certification: CCN 581818

Legal name
WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 19, 2022
Last certification
Jan 19, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 1978 in WV
Enrollment address
2101 Dudley Ave
Parkersburg, WV 26101-3462

Other NPIs with the same Medicare PAC ID 10

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

Locations

2101 Dudley Ave
Parkersburg, WV 26101
Phone (304) 488-3610

3705 Emerson Ave
Parkersburg, WV 26104
Phone (304) 865-0272

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Chris Shoop Individual Corporate DirectorBoard Member Aug 1, 2019
Bruce Dewees Individual Corporate DirectorBoard Member Jun 1, 2019
Kathy G Taylor Individual Corporate DirectorBoard Member Jun 1, 2019
Gwen Crum Individual Corporate DirectorBoard Member Jun 1, 2019
Charles Hasse Individual Corporate DirectorBoard Member Jun 1, 2019
Wirt County Health Services Association, Inc Organization, Elizabeth, WV Corporation, Non-profit Operational/Managerial Control Oct 13, 2021
Vicki Knicely Individual W-2 Managing EmployeeBilling Coordinator Mar 25, 2002
Joshua Miller Individual Corporate DirectorBoard Member Jun 1, 2019
Greg Reed Individual Corporate DirectorBoard Member Jun 1, 2019
Rob Dudley Individual Corporate OfficerCeo Sep 8, 2018

Owners & managing parties with NPI records 10

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
Ripley Family MedicineRipley, WV, CCN 511933 Federally qualified health center Operational/Managerial Control Jul 17, 1978

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1811664378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "ELIZABETH",
            "state": "WV",
            "postal_code": "261430609",
            "telephone_number": "304-275-3301",
            "fax_number": "304-275-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 DUDLEY AVE",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261013462",
            "telephone_number": "304-917-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-275-3301"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkersburg High School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wirt County Health Services Association, Inc/Parkersburg Family Care D",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Parkersburg, WV

Sources for this page

Verify at the official NPI Registry.