Active NPI
Roane County Family Health Care, Inc.
- Family Medicine Physician
- Spencer, WV
National Provider Identifier
1861494528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- ROANE COUNTY FAMILY HEALTH CARE, INC.
- Practice address
- 146 Williams Dr
Spencer, WV 25276-1826 - Phone
- (304) 927-1495
- Fax
- (304) 927-5813
- NPI assigned
- Aug 12, 2005
- Organization subpart
- Yes
- Parent organization
- ROANE COUNTY FAMILY HEALTH CARE, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stacey L Arnold
- Title
- Billing Supervisor
- Phone
- (304) 927-8177
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X |
Addresses
Primary practice location
146 Williams Dr
Spencer, WV 25276-1826
Mailing address
146 Williams Dr
Spencer, WV 25276-1826
Phone (304) 927-1495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0035046000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000548 | WV | Part B Supplier - Public Health/Welfare Agency | 3577468420 |
Receives reassigned benefits from 7 practitioners Practice locations: Spencer, WV |
| O20040804001172 | WV | Part A Provider - Federally Qualified Health Center (FQHC) | 3577468420 | Practice locations: Spencer, WV |
Federally qualified health center certification: CCN 511824
- Legal name
- ROANE COUNTY FAMILY HEALTH CARE INC
- Doing business as
- FAMILY HEALTH CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 1, 1993
- Last certification
- Feb 1, 1993
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation
- Incorporated
- Mar 11, 1983 in WV
- Enrollment address
- 146 Williams Dr
Spencer, WV 25276-1826 - Related CCNs
- 513841
National Provider Directory
National Provider Directory- Part of
- Roane County Family Health Care
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Danny Harper | Corporate Director | May 6, 2010 | |
| W-2 Managing Employee | May 6, 2010 | ||
| Joshua Downey | Corporate Officer | Jan 21, 2016 | |
| Operational/Managerial Control | Oct 15, 2007 | ||
| Theresa Parker | Operational/Managerial Control | Aug 17, 2009 | |
| John Corkrean | Operational/Managerial Control | Jul 1, 2018 | |
| John Norman | Operational/Managerial Control | Jul 1, 2018 | |
| Teresa Martin | Corporate Officer | Feb 1, 2009 | |
| W-2 Managing Employee | Feb 1, 2009 | ||
| Operational/Managerial Control | Feb 1, 2009 | ||
| Ray Deitz | Operational/Managerial Control | Jun 20, 2005 | |
| Thomas Whittier | Corporate Director | Mar 1, 1987 | |
| Kimberly Mertz | Operational/Managerial Control | Jul 18, 2016 | |
| Holly Terrell | Operational/Managerial Control | Jul 17, 2017 |
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Spencer, WV
- NPI 1801898861
Family Medicine, WV
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123804800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1674172800000",
"number": "1861494528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 WILLIAMS DR",
"city": "SPENCER",
"state": "WV",
"postal_code": "252761826",
"telephone_number": "304-927-1495",
"fax_number": "304-927-5813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 WILLIAMS DR",
"city": "SPENCER",
"state": "WV",
"postal_code": "252761826",
"telephone_number": "304-927-1495",
"fax_number": "304-927-5813"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROANE COUNTY FAMILY HEALTH CARE, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ROANE COUNTY FAMILY HEALTH CARE, INC.",
"enumeration_date": "2005-08-12",
"last_updated": "2023-01-20",
"certification_date": "2023-01-20",
"status": "A",
"authorized_official_last_name": "ARNOLD",
"authorized_official_first_name": "STACEY",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "BILLING SUPERVISOR",
"authorized_official_telephone_number": "304-927-8177"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0035046000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spencer, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; 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.