NPIMap

Organization Active NPI

Johnson Health Center

Doing business as Lynchburg Women's and Pediatric Health Services

  • Federally Qualified Health Center (FQHC)
  • Lynchburg, VA
National Provider Identifier
1821212481
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JOHNSON HEALTH CENTER
Doing business as
Lynchburg Women's and Pediatric Health Services
Practice address
2402 Atherholt Rd
Lynchburg, VA 24501-2148
Phone
(434) 200-6401
Fax
(434) 528-2639
NPI assigned
Apr 12, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Gary Campbell
Title
Ceo
Phone
(434) 455-2480

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207VX0000X
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2402 Atherholt Rd
Lynchburg, VA 24501-2148

Mailing address

134 Elon Road
Madison Heights, VA 24572
Phone (434) 455-2480

Other identifiers 1

IdentifierTypeStateIssuer
010256704MedicaidVA

Other names 1

  • Lynchburg Women's and Pediatric Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040114000510 VA Part A Provider - Federally Qualified Health Center (FQHC) 9537060413 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lynchburg, VA
O20071017000848 VA Part A Provider - Federally Qualified Health Center (FQHC) 9537060413 Practice locations: Lynchburg, VA
O20180308000764 VA Part B Supplier - Clinic/Group Practice 9537060413 Receives reassigned benefits from 26 practitioners
Practice locations: Lynchburg, VA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1821212481. Details of each certification follow.

Federally qualified health center certification: CCN 491859

Legal name
JOHNSON HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 17, 2004
Last certification
Feb 17, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in VA
Enrollment address
320 Federal St
Lynchburg, VA 24504-2306

Federally qualified health center certification: CCN 491882

Legal name
JOHNSON HEALTH CENTER
Doing business as
LYNCHBURG WOMEN'S AND PEDIATRIC HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2008
Last certification
Apr 2, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in VA
Enrollment address
2402 Atherholt Rd
Lynchburg, VA 24501-2148

Other NPIs with the same Medicare PAC ID 4

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

200 Amelon Sq
Madison Heights, VA 24572
Phone (434) 929-1095

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Sherry Gentry Individual Corporate DirectorMember Mar 18, 2016
Mary Brophy Individual Corporate DirectorSecretary Aug 18, 2014
Corporate DirectorBoard Member Oct 1, 2014
Destin Tanner Individual Corporate DirectorMember Nov 21, 2021
Gary Campbell Individual Corporate OfficerCeo Aug 1, 2014
W-2 Managing EmployeeCeo Aug 1, 2014
Corporate OfficerCeo Jul 22, 2014
Operational/Managerial ControlCeo Jul 22, 2014
James Tyler Individual Corporate DirectorMember Nov 21, 2021
Corporate DirectorChair Nov 21, 2021
Sandy Glass Individual Corporate DirectorTreasurer Mar 18, 2017
Corporate DirectorTreasurer Jul 9, 2017
Gary Hutcherson Individual Corporate DirectorVice Chair Dec 17, 2018
Jennifer Hall Individual Corporate DirectorMember Mar 18, 2017
Debra Wood Drake Individual Corporate DirectorChair May 19, 2014
Corporate DirectorBoard Member May 19, 2014
Mehgan McCrickard Individual Operational/Managerial ControlChief Operations Officier Aug 10, 2009
Corporate OfficerCoo Oct 4, 2019
Robert Golcheski Individual Corporate DirectorMember Mar 18, 2016
Theresa McCrickard Individual Corporate DirectorMember Mar 18, 2016
Arthur F Fisher Individual Corporate DirectorMember Aug 26, 2019
Lasheika McCoy Individual Corporate DirectorSecretary Apr 1, 2023
Brian Freeman Individual Corporate DirectorVice Chair Feb 1, 2024
Matt Adkins Individual Corporate DirectorBoard Member Aug 1, 2024
Gabrielle Azcona Individual Corporate DirectorBoard Member Nov 1, 2024
Mary Ruth Davis Individual Corporate DirectorBoard Member Dec 1, 2024
Sakieya Royster Individual Corporate DirectorBoard Member Feb 1, 2025
Kyle West Individual Corporate DirectorBoard Member Feb 1, 2025
Claudia Tucker Individual Corporate DirectorBoard Member Feb 1, 2025
Joe Tucker Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1821212481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ELON ROAD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "24572",
            "telephone_number": "434-455-2480",
            "fax_number": "434-455-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 ATHERHOLT RD",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012148",
            "telephone_number": "434-200-6401",
            "fax_number": "434-528-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "434-455-2480"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "010256704",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lynchburg Women's and Pediatric Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.