Community Care of West Virginia Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY CARE OF WEST VIRGINIA INC

Doing business as

Adamston Elementary School Wellness Center
Genesis Youth Crisis Wellness Center

Practice address

591 Kappa Sigma Pi Dr
Clarksburg, WV 26301-7674

Phone

(304) 473-5600

Fax

(304) 472-1341

NPI assigned

Apr 13, 2015

Last updated

Jan 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dora L Potasnik

Title

Credentialing

Phone

(304) 587-2541

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Adamston Elementary School Wellness Center Doing business as
• Genesis Youth Crisis Wellness Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851787121. Details of each certification follow.

• CCN 511061 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 511061

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

GENESIS YOUTH CRISIS WELLNESS CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 16, 2015

Last certification

Apr 16, 2015

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 1984 in WV

Enrollment address

591 Kappa Sigma Pi Dr
Clarksburg, WV 26301-7674

Locations

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.

Owners & managing parties with NPI records 3

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

• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863

  Corporate Officer

  CMS ownership
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760

  Corporate Officer

  CMS ownership
• Kevin Douglas Junkins, MD

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1629344858

  Corporate Officer

  CMS ownership

All facility ownership & control disclosures 1

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

Practitioners 98

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.

• Joshua Scott Abbott, DDS

  • Dentist
  • Green Bank, WV
  • NPI 1891041406
  Medicare reassignment NPD
• Laura Evelyn Abbott, DDS

  • Dentist
  • Green Bank, WV
  • NPI 1093061608
  Medicare reassignment NPD
• Melissa S Dodrill, M.D.

  • Family Medicine Physician
  • West Milford, WV
  • NPI 1871887349
  Medicare reassignment NPD
• Kelly W Dunavant, DO

  • Pain Medicine Physician
  • West Milford, WV
  • NPI 1609047109
  Medicare reassignment NPD
• Lesley Groves, N.P.

  • Family Nurse Practitioner
  • Clarksburg, WV
  • NPI 1497936173
  Medicare reassignment NPD
• Benjamin Douglas Hines, MD

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1144664863
  Medicare reassignment NPD
• Kevin Douglas Junkins, MD

  • Psychiatry Physician
  • Bridgeport, WV
  • NPI 1629344858
  Medicare reassignment NPD
• Genevieve F Larimer Dunn, FNP-BC

  • Family Nurse Practitioner
  • Buckhannon, WV
  • NPI 1861708513
  Medicare reassignment NPD
• Raymond Leonard, MD

  • Pediatrics Physician
  • Rock Cave, WV
  • NPI 1376769984
  Medicare reassignment NPD
• Brandy Nicole Phares, FNP

  • Family Nurse Practitioner
  • Clarksburg, WV
  • NPI 1457710543
  Medicare reassignment NPD
• Heather Anne Radcliffe, LICSW ACSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1649539396
  Medicare reassignment NPD
• Adam Christopher Stonestreet, LICSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1245704980
  Medicare reassignment NPD

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1851787121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 KAPPA SIGMA PI DR",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263017674",
            "telephone_number": "304-473-5600",
            "fax_number": "304-472-1341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 KAPPA SIGMA PI DR",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263017674",
            "telephone_number": "304-473-5600",
            "fax_number": "304-472-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "2306-6736",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adamston Elementary School Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genesis Youth Crisis Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charissa Collins
• Kayla R Collins
• Ashley Taylor Combs, LPN
• Shannon Commodore, PHARM D.
• Community Care of West Virginia (Community Care Pharmacy of Clarksburg)
• Community Care of West Virginia, Inc. (Community Care of Clarksburg)
• Community Care of West Virginia, Inc. (Mountaineer Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Liberty Middle School Wellness Center)
• Community Care of West Virginia, Inc. (North View Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Robert C. Byrd High Wellness Center)

• Federally Qualified Health Center (FQHC) in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Federally Qualified Health Center (FQHC) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.