NPIMap

Organization Active NPI

Johnson Health Center

Doing business as Amherst County Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Madison Heights, VA
National Provider Identifier
1972858660
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JOHNSON HEALTH CENTER
Doing business as
Amherst County Community Health Center
Practice address
109 Clearview Rd
Madison Heights, VA 24572
Phone
(434) 455-2480
Fax
(434) 455-2487
NPI assigned
Jul 18, 2012
Last updated
Jun 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

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

Authorized official

Name
Gary Campbell
Title
Ceo
Phone
(434) 455-2480

Specialties & licenses 1

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

Addresses

Primary practice location

109 Clearview Rd
Madison Heights, VA 24572

Mailing address

134 Elon Rd
Madison Heights, VA 24572-2536
Phone (434) 455-2480

Other names 1

  • Amherst County Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040709000047 VA Part B Supplier - Clinic/Group Practice 9537060413 Receives reassigned benefits from 73 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bedford, VA; Lynchburg, VA; Madison Heights, VA
O20120814000534 VA Part A Provider - Federally Qualified Health Center (FQHC) 9537060413 Practice locations: Madison Heights, VA
O20231011001715 VA Part B Supplier - Pharmacy 9537060413 Practice locations: Madison Heights, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972858660. Details of each certification follow.

Federally qualified health center certification: CCN 491918

Legal name
JOHNSON HEALTH CENTER
Doing business as
AMHERST COUNTY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 27, 2012
Last certification
Aug 27, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 2004 in VA
Enrollment address
109 Clearview Rd
Madison Heights, VA 24572-2536

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

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
49D2057844Amherst County Community Health Center109 Clearview Road, Madison Heights, VA 24572Certificate of waiverApr 26, 2027

National Provider Directory

National Provider Directory

Locations

1003 5th St
Lynchburg, VA 24504
Phone (434) 609-0708

2402 Atherholt Rd
Lynchburg, VA 24501
Phone (434) 200-6401

109 Clearview Rd
Madison Heights, VA 24572
Phone (434) 929-1400

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
Sherry Gentry Individual Corporate DirectorMember Jul 8, 2016
Mary Brophy Individual Corporate DirectorSecretary Aug 18, 2014
Destin Tanner Individual Corporate DirectorMember Nov 21, 2021
Gary Campbell Individual Corporate DirectorCeo Aug 1, 2014
Operational/Managerial ControlCeo Aug 1, 2014
James Tyler Individual Corporate DirectorMember Nov 21, 2021
Sandy Glass Individual Corporate DirectorSecretary Jul 9, 2017
Debra Wood Drake Individual Corporate DirectorChair May 19, 2014
Mehgan McCrickard Individual Corporate DirectorChief Operating Officer Aug 1, 2014
Operational/Managerial ControlChief Operating Officer Aug 1, 2014
Robert Golcheski Individual Corporate DirectorMember Jul 8, 2016
Theresa McCrickard Individual Corporate DirectorMember Jul 8, 2016
Joe Tucker Individual Corporate DirectorChairman Apr 1, 2023
Nicolette Baez Individual Corporate DirectorBoard Member Jan 1, 2023

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1972858660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ELON RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "245722536",
            "telephone_number": "434-455-2480",
            "fax_number": "434-455-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 CLEARVIEW RD",
            "city": "MADISON HEIGHTS",
            "state": "VA",
            "postal_code": "24572",
            "telephone_number": "434-455-2480",
            "fax_number": "434-455-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2024-06-07",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "434-455-2480"
    },
    "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": "Amherst County Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison Heights, VA

Sources for this page

Verify at the official NPI Registry.