NPIMap

Organization Active NPI

Valley Professionals Community Health Center Inc

Doing business as VPCHC-Clinton Dental

  • Federally Qualified Health Center (FQHC)
  • Clinton, IN
National Provider Identifier
1972312973
Registry record updated Jan 9, 2025
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
Doing business as
VPCHC-Clinton Dental
Practice address
1792 E State Road 163
Clinton, IN 47842-7327
Phone
(765) 828-3241
NPI assigned
Jan 3, 2025
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1792 E State Road 163
Clinton, IN 47842-7327

Mailing address

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

Other names 1

  • VPCHC-Clinton Dental Doing business as

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
O20250311000919 IN Part A Provider - Federally Qualified Health Center (FQHC) 7618067265 Practice locations: Clinton, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972312973. Details of each certification follow.

Federally qualified health center certification: CCN C51083

Legal name
VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
Doing business as
VPCHC - CLINTON DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 13, 2025
Last certification
Mar 13, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1792 E State Road 163
Clinton, IN 47842-7327

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

1792 E State Road 163
Clinton, IN 47842
Phone (765) 828-3241

1793 E State Rd 163
Clinton, IN 47842

1810 Lafayette Rd
Crawfordsville, IN 47933
Phone (765) 362-2800

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Loretta Johnson Individual Operational/Managerial Control Jan 12, 2025
Terry J Warren Individual Corporate Officer Jan 20, 2025
W-2 Managing Employee Jan 20, 2025
Michael Miller Individual Corporate Officer Jan 20, 2025
Kristin Craig Individual Corporate Officer Jan 20, 2025
Mark Russell Individual Corporate Officer Jan 20, 2025
Daniel Hardesty Individual Corporate Officer Jan 20, 2025
Ronald Hodge Individual Corporate Officer Jan 20, 2025
Marina Wolfe Individual Corporate Officer Jan 20, 2025
Danielle M Cundiff Individual Corporate Officer Jan 20, 2025
Dawn Newnum Individual Corporate Director Jan 20, 2025
Jessica Marie Purcell Individual Corporate Director Jan 20, 2025
Jill Pastore Individual Corporate Officer Jan 20, 2025
Michael Rentfro Individual Corporate Officer Jan 20, 2025
Christopher M Williams Individual Corporate Director Jan 20, 2025

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 86

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 86

NPI Registry JSON

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

{
    "created_epoch": "1735862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1972312973",
    "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": "1792 E STATE ROAD 163",
            "city": "CLINTON",
            "state": "IN",
            "postal_code": "478427327",
            "telephone_number": "765-828-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "765-828-1003"
    },
    "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": "VPCHC-Clinton Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VPCHC-Clinton Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, IN

Sources for this page

Verify at the official NPI Registry.