NPIMap

Organization Active NPI

Central Virginia Health Services Inc

Doing business as CVHS King William

  • Federally Qualified Health Center (FQHC)
  • Aylett, VA
National Provider Identifier
1972631661
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL VIRGINIA HEALTH SERVICES INC
Doing business as
CVHS King William
Practice address
11814 King William Rd
Aylett, VA 23009-4103
Phone
(804) 769-3022
Fax
(804) 769-1253
NPI assigned
Mar 2, 2007
Last updated
Dec 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Authorized official

Name
Charles Allbaugh
Title
Cfo
Phone
(434) 581-4073

Specialties & licenses 1

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

Addresses

Primary practice location

11814 King William Rd
Aylett, VA 23009-4103

Mailing address

PO Box 220
New Canton, VA 23123-0220
Phone (434) 581-4073

Other identifiers 1

IdentifierTypeStateIssuer
007602774MedicaidVA

Other names 1

  • CVHS King William Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030107000010 VA Part A Provider - Federally Qualified Health Center (FQHC) 0345158432 Practice locations: Aylett, VA
O20031119000823 VA Part B Supplier - Clinic/Group Practice 0345158432 Receives reassigned benefits from 134 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Montross, VA; Prince George, VA; Petersburg, VA; New Canton, VA; Louisa, VA; Hopewell, VA; Fredericksburg, VA; Farmville, VA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972631661. Details of each certification follow.

Federally qualified health center certification: CCN 491822

Legal name
CENTRAL VIRGINIA HEALTH SERVICES INC
Doing business as
KING WILLIAM DAWN COMMUNITY DOCTORS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Most recent change of ownership
Jan 1, 2000 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 1970 in VA
Enrollment address
11814 King William Rd
Aylett, VA 23009-4103

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 16

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

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0226182CVHS King William11814 King William Road, Aylett, VA 23009Provider-performed microscopyDec 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central VA Health Servi24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Locations

11814 King William Rd
Aylett, VA 23009
Phone (804) 769-3002

18849 Kings Hwy
Montross, VA 22520
Phone (804) 493-1124

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
Tamica Williams Individual Corporate DirectorBoard Member Dec 1, 2014
Samuel Bateman Individual Corporate DirectorBoard Secretary Mar 21, 2003
Randall Thomas Bashore Individual W-2 Managing EmployeeMedical Director Jul 8, 1985
Rosario-Ninel E Foss Individual Corporate DirectorBoard Member Nov 1, 2016
Evelyn Benet Individual Corporate DirectorBoard Member Oct 1, 2014
Byron Adkins Individual Corporate DirectorBoard Member Mar 21, 2003
Carolyn Perry Individual Corporate DirectorBoard Member Dec 1, 2014
Debra Jones Individual Corporate DirectorBoard Member Dec 1, 2014
Peggy Scott Individual Corporate DirectorBoard Member Feb 1, 1996
Charles Allbaugh Individual Corporate Officer Sep 18, 1995
W-2 Managing EmployeeCfo Sep 18, 1995
Jearline Taylor Individual Corporate DirectorBoard Member Jan 1, 2000
Ralph Moore Individual Corporate DirectorBoard Member Sep 6, 2012
Frankie Sheridan Individual Corporate DirectorBoard President Mar 21, 2003
Robert C Smith Individual Corporate DirectorBoard Member Dec 1, 2007

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 1

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

FacilityTypeRoleSince
CVHS PetersonCharlottesville, VA, CCN 491958 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2017

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1972631661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "NEW CANTON",
            "state": "VA",
            "postal_code": "231230220",
            "telephone_number": "434-581-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11814 KING WILLIAM RD",
            "city": "AYLETT",
            "state": "VA",
            "postal_code": "230094103",
            "telephone_number": "804-769-3022",
            "fax_number": "804-769-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VIRGINIA HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "ALLBAUGH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "434-581-4073"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007602774",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVHS King William",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aylett, VA

Sources for this page

Verify at the official NPI Registry.