NPIMap

Organization Active NPI

New River Health Association, Inc.

Doing business as New River Health Lester Square

  • Federally Qualified Health Center (FQHC)
  • Sophia, WV
National Provider Identifier
1922811744
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEW RIVER HEALTH ASSOCIATION, INC.
Doing business as
New River Health Lester Square
Practice address
821 Robert C Byrd Dr.
Sophia, WV 25921
Phone
(304) 469-2905
NPI assigned
Jan 27, 2025
Last updated
Jan 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Marissa Johnson
Title
Credentialing Officer
Phone
(304) 469-2905

Specialties & licenses 1

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

Addresses

Primary practice location

821 Robert C Byrd Dr.
Sophia, WV 25921

Mailing address

497 Mall Rd
Oak Hill, WV 25901-6216
Phone (304) 469-2905

Other names 1

  • New River Health Lester Square Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210903001544 WV Part B Supplier - Clinic/Group Practice 2365348596 Receives reassigned benefits from 49 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beckley, WV; Oak Hill, WV; Sophia, WV; Welch, WV
O20250924002277 WV Part A Provider - Federally Qualified Health Center (FQHC) 2365348596 Practice locations: Sophia, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922811744. Details of each certification follow.

Federally qualified health center certification: CCN 581071

Legal name
NEW RIVER HEALTH ASSOCIATION INC
Doing business as
NEW RIVER HEALTH LESTER SQUARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 18, 2025
Last certification
Aug 18, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
821 Robert C Byrd Dr.
Sophia, WV 25921

Other NPIs with the same Medicare PAC ID 21

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

View all 21

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
Tax ID family
New River Health Associ9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

800 Independence Rd
Sophia, WV 25921
Phone (681) 539-3337

30 Grizzley Ln
Summersville, WV 26651
Phone (304) 883-3900

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
Joe Brouse Individual Other Apr 1, 2016
Angela M Barker Individual Corporate Officer Feb 1, 2014
Sharon Bradley Individual Other May 1, 2015
Nathan Hollister Individual Other Jan 1, 2020
Marissa Johnson Individual W-2 Managing EmployeeAd; Jan 7, 2019
Erin Reid Individual Other Jan 1, 2020
Robert Simmons Individual Other Jul 1, 2006
Paul Lively Individual Other Jul 1, 1978
Rose Michaels Individual Other Nov 1, 2014
Gabriel Pena Individual Other Nov 1, 2013
John R Schultz Individual Other Jan 7, 2013
Evelyn Hizer Individual Other Jul 1, 1995
Mark V Sundstrom Individual Other Jun 30, 2023
Steve Pawlus Individual Other Aug 27, 2020
Angela Sundstrom Individual Other Feb 1, 2016
Gary Hairston Individual Other Sep 1, 2012

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 11

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

FacilityTypeRoleSince
New River Health - SophiaSophia, WV, CCN 511956 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Intermediate School Based Health CenterOak Hill, WV, CCN 511963 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
Oak Hill High School Based Health CenterOak Hill, WV, CCN 511962 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Nicholas County School Based Health CenterSummersville, WV, CCN 511965 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Coal City Elementary School Based Health CenterCoal City, WV, CCN 511969 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
Independence School Based Health CenterCoal City, WV, CCN 511970 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 27, 1976
New River Health - SummersvilleSummersville, WV, CCN 511124 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 1, 2017
Independence Middle School Based Health CenterCoal City, WV, CCN 511161 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 26, 2018
Jun 26, 2018
Fayetteville PK-8 School Based Health CenterFayetteville, WV, CCN 511179 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - SmithersSmithers, WV, CCN 511189 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976
New River Health - Oak HillOak Hill, WV, CCN 581809 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 27, 1976

Owned or controlled facilities with NPI records 12

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1922811744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 MALL RD",
            "city": "OAK HILL",
            "state": "WV",
            "postal_code": "259016216",
            "telephone_number": "304-469-2905",
            "fax_number": "304-465-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 ROBERT C BYRD DR.",
            "city": "SOPHIA",
            "state": "WV",
            "postal_code": "25921",
            "telephone_number": "304-469-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW RIVER HEALTH ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "304-469-2905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New River Health Lester Square",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sophia, WV

Sources for this page

Verify at the official NPI Registry.