NPIMap

Organization Active NPI

Monroe County Health Center Board of Trustees

  • Federally Qualified Health Center (FQHC)
  • Lindside, WV
National Provider Identifier
1912440298
Registry record updated Nov 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Practice address
142 James Monroe Dr
Lindside, WV 24951-7168
Phone
(304) 753-5940
NPI assigned
Nov 18, 2016
Last updated
Nov 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2022

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

Authorized official

Name
Michelle Ballard
Title
Coo
Phone
(304) 772-3034

Specialties & licenses 1

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

Addresses

Primary practice location

142 James Monroe Dr
Lindside, WV 24951-7168

Mailing address

PO Box 590
Union, WV 24983-0590
Phone (304) 772-3064

Other names 1

  • JAMES MONROE WELLNESS CENTER Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040330001675 WV Part B Supplier - Public Health/Welfare Agency 3173432671 Receives reassigned benefits from 29 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Union, WV; Peterstown, WV; Lindside, WV; Forest Hill, WV
O20170206000717 WV Part A Provider - Federally Qualified Health Center (FQHC) 3173432671 Practice locations: Lindside, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912440298. Details of each certification follow.

Federally qualified health center certification: CCN 511122

Legal name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Doing business as
JAMES MONROE WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 29, 2016
Last certification
Nov 29, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2003 in WV
Enrollment address
142 James Monroe Dr
Lindside, WV 24951-7168

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

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 12

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

NameRoleSinceShare
Sheila Johnson Individual Corporate DirectorBoard Member Jan 1, 2015
Cathi F Biggs Individual Corporate DirectorBoard Vice Chair Jan 1, 2011
Wayne D Spangler Individual Corporate DirectorBoard Member Jan 1, 2015
Shirley H Dixon Individual Corporate DirectorBoard Member Jan 1, 2013
Jeff Jones Individual Corporate DirectorBoard Member Jan 1, 2016
Walter Marsden Individual Corporate DirectorBoard Member Jan 1, 2011
Janet W Caulkins Individual Corporate DirectorBoard Member Jan 1, 2015
Shelby Jennings Individual Corporate DirectorBoard Member Jan 1, 2011
Michelle Ballard Individual Corporate OfficerCoo Sep 1, 2011
W-2 Managing EmployeeCoo Sep 1, 2011
Jeffry a Pritt Individual Corporate DirectorBoard Member Jan 1, 2013
Debbie D Snead Individual Corporate DirectorBoard Member Jan 1, 2015
Melissa F Boggs Individual Corporate DirectorBoard Secretary Jan 1, 2013

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Craig County Health CenterNew Castle, VA, CCN 491881 Federally qualified health center Operational/Managerial Control (100%) Aug 30, 2007
Monroe Health CenterUnion, WV, CCN 511837 Federally qualified health center Operational/Managerial Control (100%) Jun 30, 2006

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1479427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1912440298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "UNION",
            "state": "WV",
            "postal_code": "249830590",
            "telephone_number": "304-772-3064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 JAMES MONROE DR",
            "city": "LINDSIDE",
            "state": "WV",
            "postal_code": "249517168",
            "telephone_number": "304-753-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-18",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "304-772-3034"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JAMES MONROE WELLNESS CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "JAMES MONROE WELLNESS CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lindside, WV

Sources for this page

Verify at the official NPI Registry.