Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

2289-7283 Issued in WV

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

Community Care of Buckhannon

Practice address

33-37 W Main Street
Buckhannon, WV 26201-2235

Phone

(304) 924-6262

Fax

(304) 924-5460

NPI assigned

Aug 28, 2016

Last updated

Nov 29, 2022By 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 Coordinator

Phone

(304) 587-2541

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Community Care of Buckhannon 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 1891241030. Details of each certification follow.

• CCN 511110 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 511110

Legal name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

COMMUNITY CARE OF BUCKHANNON

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 31, 2016

Last certification

Aug 31, 2016

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 1984 in WV

Enrollment address

33-37 W Main Street
Buckhannon, WV 26201-2235

Locations

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.

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

Practitioners 117

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.

• Jennifer Abel, FNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Buckhannon, WV
  • NPI 1396152740
  Medicare reassignment NPD
• Allyson Malone Andrews, PA-C

  • Medical Physician Assistant
  • Buckhannon, WV
  • NPI 1164405569
  Medicare reassignment NPD
• Joshua Steven Baker, PAC

  • Physician Assistant
  • West Milford, WV
  • NPI 1003897497
  Medicare reassignment NPD
• Nicholas Joel Baker, PA-C

  • Physician Assistant
  • Buckhannon, WV
  • NPI 1225177504
  Medicare reassignment NPD
• Kimberly R Becher, MD

  • Family Medicine Physician
  • Clay, WV
  • NPI 1528351863
  Medicare reassignment NPD
• Paula Blount, PA

  • Physician Assistant
  • Charleston, WV
  • NPI 1700862091
  Medicare reassignment NPD
• Cheryl Ann Bowers, PA-C

  • Physician Assistant
  • Buckhannon, WV
  • NPI 1407021561
  Medicare reassignment NPD
• Patricia L Collett, PA-C

  • Medical Physician Assistant
  • Rock Cave, WV
  • NPI 1528008760
  Medicare reassignment NPD
• Diana Lynn Cooper, FNP-C

  • Family Nurse Practitioner
  • Weston, WV
  • NPI 1356969927
  Medicare reassignment NPD
• Penny N Cutlip, FNP

  • Nurse Practitioner
  • Elkins, WV
  • NPI 1972237857
  Medicare reassignment NPD
• Melany W Davis, LICSW

  • Clinical Social Worker
  • Bridgeport, WV
  • NPI 1851914105
  Medicare reassignment NPD
• Kelsey Ayne Dean, FNP-C

  • Family Nurse Practitioner
  • Buckhannon, WV
  • NPI 1891508909
  Medicare reassignment NPD

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1891241030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33-37 W MAIN STREET",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262012236",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-37 W MAIN STREET",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262012235",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "304-587-2541"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "2289-7283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF WV BUSINESS LICENSE",
            "identifier": "2289-7283",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care of Buckhannon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Care of Buckhannon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Community Care of West Virginia, Inc. (West Virginia Wesleyan College Wellness Center)
• Community Care of West Virginia, Inc. (Union Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Buckhannon Academy Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Washington District Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Tennerton Elementary School Wellness Center)
• Community Care of West Virginia, Inc. (Buckhannon Upshur Middle School Wellness Center)
• Community Care Pharmacy of West Virginia Inc (Community Care Pharmacy of Buckhannon)
• Conde Family Dentistry
• Andrea Conde
• Kevin Michael Conde, DDS

• Federally Qualified Health Center (FQHC) in Buckhannon, WV
• Providers in Buckhannon, 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 Nov 29, 2022; 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.