NPIMap

Organization Active NPI

Valley Professionals Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • West Terre Haute, IN
National Provider Identifier
1902567977
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Practice address
601 W National Ave
West Terre Haute, IN 47885-1303
Phone
(812) 244-1515
Fax
(812) 244-1519
NPI assigned
Jan 3, 2022
Last updated
Jan 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Authorized official

Name
Terry J Warren
Title
Ceo
Phone
(765) 828-1003

Specialties & licenses 1

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

Addresses

Primary practice location

601 W National Ave
West Terre Haute, IN 47885-1303

Mailing address

777 S Main St Ste 100
Clinton, IN 47842-2493
Phone (765) 828-1003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071219000487 IN Part B Supplier - Clinic/Group Practice 7618067265 Receives reassigned benefits from 94 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Terre Haute, IN; Terre Haute, IN; Rockville, IN; Clinton, IN; Crawfordsville, IN; Bloomingdale, IN; Cayuga, IN
O20220517001460 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618067265 Practice locations: West Terre Haute, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902567977. Details of each certification follow.

Federally qualified health center certification: CCN 151139

Legal name
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Doing business as
VPCHC-WEST TERRE HAUTE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2022
Last certification
May 10, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
601 W National Ave
West Terre Haute, IN 47885-1303

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Valley Professionals Community Health Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

777 S Main St
Ste 100
Clinton, IN 47842
Phone (765) 828-1003

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Mary Helderman Individual Corporate Director Jan 1, 2022
Loretta Johnson Individual Corporate Director Jan 1, 2022
Jacqueline Mathis Individual Corporate Director Jan 1, 2024
David Allen Chapman Individual Corporate Director Jan 1, 2022
Terry J Warren Individual Corporate OfficerCeo Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022
Michael Miller Individual Corporate Director Jan 1, 2024
Kristin Craig Individual Corporate Director Jan 1, 2022
Mark Russell Individual Corporate Director Jan 1, 2022
Ronald Hodge Individual Corporate Director Jan 1, 2023
Marina Wolfe Individual Corporate Director Jan 1, 2023
John Michael Major Individual Corporate Director Jan 1, 2022
Danielle M Cundiff Individual Corporate Officer Sep 1, 2022
W-2 Managing Employee Sep 1, 2022
Louis Bonomo Individual Corporate Officer Mar 7, 2025
Jessica Marie Purcell Individual Corporate Director Jan 1, 2022
Jill Pastore Individual Corporate Director Jan 1, 2022
Christopher M Williams Individual Corporate Director Jan 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1902567977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 S MAIN ST STE 100",
            "city": "CLINTON",
            "state": "IN",
            "postal_code": "478422493",
            "telephone_number": "765-828-1003",
            "fax_number": "765-828-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W NATIONAL AVE",
            "city": "WEST TERRE HAUTE",
            "state": "IN",
            "postal_code": "478851303",
            "telephone_number": "812-244-1515",
            "fax_number": "812-244-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-828-1003"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Terre Haute, IN

Sources for this page

Verify at the official NPI Registry.