NPIMap

Organization Active NPI

West Virginia School of Osteopathic Medicine Clinic Inc D/B/a Robert C. Byrd Clinic

Doing business as Robert C Byrd Clinic

  • Family Medicine Physician
  • Lewisburg, WV
National Provider Identifier
1871539296
Registry record updated Aug 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE CLINIC INC D/B/A ROBERT C. BYRD CLINIC
Doing business as
Robert C Byrd Clinic
Practice address
1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone
(304) 645-3220
Fax
(304) 645-4103
NPI assigned
Jun 22, 2006
Last updated
Aug 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2026

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

Authorized official

Name
Mary P Nemcik
Title
Executive Director
Phone
(304) 647-1242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1464 Jefferson St N
Lewisburg, WV 24901-1380

Mailing address

1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone (304) 645-3220

Other identifiers 1

IdentifierTypeStateIssuer
0006045000MedicaidWV

Other names 1

  • Robert C Byrd Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000104 WV Part B Supplier - Clinic/Group Practice 0941113427 Receives reassigned benefits from 45 practitioners
Practice locations: Rupert, WV; Lewisburg, WV
O20180214002435 WV Part A Provider - Rural Health Clinic 0941113427 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lewisburg, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871539296. Details of each certification follow.

Rural health clinic certification: CCN 513920

Legal name
WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE CLINIC INC
Doing business as
ROBERT C BYRD CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 6, 2018
Last certification
Apr 17, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 30, 1975 in WV
Enrollment address
1464 Jefferson St N
Lewisburg, WV 24901-1380

Other NPIs with the same Medicare PAC ID 1

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
West Virginia School of Osteopathic Medicine Clinic Inc Organization, Lewisburg, WV Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2017 100%
Mary Page Nemcik Individual W-2 Managing EmployeeAd; Aug 1, 2024
Operational/Managerial ControlExecutive Director Aug 1, 2024
Jennifer N Rose Individual Corporate DirectorMember/Board of Directors Dec 20, 2022
Dreama Walker Individual W-2 Managing EmployeeDir Patient Services /Credentialing Aug 1, 2024
Operational/Managerial ControlDir Patient Services and Credential Aug 1, 2024

Owners & managing parties with NPI records 2

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
Robert C Byrd ClinicLewisburg, WV, CCN 513920 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2017

Owned or controlled facilities with NPI records 1

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

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": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787097600000",
    "number": "1871539296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "304-645-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE CLINIC INC D/B/A ROBERT C. BYRD CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A",
        "authorized_official_last_name": "NEMCIK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-647-1242"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006045000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robert C Byrd Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Robert C Byrd Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewisburg, WV

Sources for this page

Verify at the official NPI Registry.