NPIMap

Organization Active NPI

Community Action Committee of Pike County

  • Federally Qualified Health Center (FQHC)
  • Waverly, OH
National Provider Identifier
1821661372
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Practice address
13800 US Highway 23
Waverly, OH 45690-9402
Phone
(740) 947-2480
NPI assigned
Jul 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Authorized official

Name
Keith Eric Pitts
Title
Executive Director
Phone
(740) 289-2371

Specialties & licenses 1

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

Addresses

Primary practice location

13800 US Highway 23
Waverly, OH 45690-9402

Mailing address

941 Market St
Piketon, OH 45661-9757
Phone (740) 289-2371

Other names 1

  • VALLEY VIEW 23 NORTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211102000567 OH Part A Provider - Federally Qualified Health Center (FQHC) 3173432762 Practice locations: Waverly, OH

Federally qualified health center certification: CCN 721918

Legal name
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Doing business as
VALLEY VIEW 23 NORTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 26, 2021
Last certification
Oct 26, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1965 in OH
Enrollment address
13800 US Highway 23
Waverly, OH 45690-9402

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Community Action Commit32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Locations

1414 Piketon Rd
Piketon, OH 45661
Phone (740) 289-4456

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Sandi King Individual Corporate Director Jan 19, 2023
Pamela Johnson Individual Corporate DirectorBoard Member Mar 22, 2018
Phyllis Snyder Individual Corporate Director Mar 20, 2008
Lindsay Schrader Individual Corporate DirectorBoard Member May 21, 2015
Community Action Committee of Pike County Organization, Piketon, OH Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 30, 2021 100%
Rick Patrick Individual Corporate DirectorBoard Member Mar 28, 2004
Blaine Beekman Individual Corporate DirectorBoard Member Nov 18, 2021
Keith Pitts Individual Corporate OfficerExecutive Director Apr 25, 2016
Lori Salisbury Individual W-2 Managing EmployeeInsurance Credentialing Specialist Sep 12, 2008
Jerry Miller Individual Corporate DirectorBoard Member Mar 18, 2021
Justin Brewster Individual Corporate DirectorBoard Member Jun 22, 2017
Chandler Grooms Individual Corporate Director Apr 20, 2023
Jamie Adams Individual Corporate Director Sep 21, 2023
Anthony Moraleja Individual Corporate DirectorBoard Member Apr 15, 2021
Rob Junk Individual Corporate DirectorBoard Member Mar 20, 2014
Paul Price Individual Corporate DirectorBoard Member Jan 19, 2017
Chase Brown Individual Corporate DirectorBoard Member Jul 15, 2021
David Bevens Individual Corporate Director May 9, 2022

Owners & managing parties with NPI records 8

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
Manchester Family Health CenterManchester, OH, CCN 361050 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 19, 2014

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1821661372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 MARKET ST",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "456619757",
            "telephone_number": "740-289-2371",
            "fax_number": "740-289-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 US HIGHWAY 23",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456909402",
            "telephone_number": "740-947-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ACTION COMMITTEE OF PIKE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "PITTS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "740-289-2371"
    },
    "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": "VALLEY VIEW 23 NORTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VALLEY VIEW 23 NORTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waverly, OH

Sources for this page

Verify at the official NPI Registry.