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Community Care of West Virginia, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Buckhannon, WV

NPI 1992144273 · NPPES record last updated Jun 19, 2013

Key facts

NPI
1992144273
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
2287-7364 (WV)
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Practice address
RR 6 Box 303
Buckhannon, WV 26201-8830
Phone
(304) 472-1520
Fax
(304) 472-6864
NPI assigned
Jun 19, 2013
Organization subpart
Yes
Parent organization (as reported)
COMMUNITY CARE OF WEST VIRGINIA, INC.

Authorized official

Name
Dora L Potasnik
Title
Credentialing
Phone
(304) 587-2541

Owners & managing parties with NPI records 2

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

Other NPIs on the same Medicare enrollment 1

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

Practitioners 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 97

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in WV

Federally qualified health center certification: CCN 511039

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
BUCKHANNON-UPSHUR MIDDLE SCHOOL WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 5, 2013
Last certification
Nov 5, 2013
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
303 RR 6
Buckhannon, WV 26201-8830

Federally qualified health center certification: CCN 511038

Legal name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Doing business as
BUCKHANNON-UPSHUR MIDDLE SCHOOL WELNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 5, 2013
Last certification
Nov 5, 2013
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jul 1, 1984 in WV
Enrollment address
303 RR 6
Buckhannon, WV 26201-8830

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Sarah Chouinard
Individual 		Corporate Officer
Cmo		 Sep 1, 2003
Corporate Officer
Chief Medical Officer		 Nov 5, 2013
Dora L. Potasnik
Individual 		W-2 Managing Employee
Credentialing		 Sep 16, 2013
W-2 Managing Employee
Credentialing		 Jan 9, 2012
Juston Chad Morrison
Individual 		Corporate Director Apr 10, 2017
Corporate Director
Board Member		 Jan 1, 2020
Hillary Nicole Tenney
Individual 		W-2 Managing Employee
Credentialing Coordinator		 Aug 1, 2018
W-2 Managing Employee
Credentialing Coordinator		 Aug 1, 2019
Elisabeth M Samples
Individual 		Corporate Director
Board Secretary		 Jan 1, 2018
Michele Williams
Individual 		Corporate Officer
Compliance Officer		 Dec 12, 2005
Corporate Officer
Compliance Officer		 Nov 5, 2013
Jeffrey Jenkins
Individual 		Corporate Officer
Cfo		 Apr 4, 2022
Richard G Simon
Individual 		Corporate Officer
Ceo		 Sep 13, 1993 100%
David B Malcomb
Individual 		Corporate Director Jan 1, 2018
Corporate Director
Board Member		 Jan 1, 2020
Selah Raines
Individual 		Corporate Director Jan 1, 2020
Corporate Director
Board Member		 Jan 1, 2020
David D Taylor
Individual 		Corporate Director Mar 14, 2016
Corporate Director
Board Member		 Mar 14, 2016
Katherine Anne Horner
Individual 		Corporate Director
Board Vice- President		 Jan 14, 2019
Corporate Director
Board Vice-President		 Jan 14, 2019
Patricia Louise Collett
Individual 		Corporate Officer
Coo		 Nov 18, 2000
Corporate Officer
Coo		 Nov 5, 2013
Steven Roy Flaughers
Individual 		Corporate Director Jan 14, 2019
Corporate Director
Board Member		 Jan 14, 2019
Rosemary M Thomas
Individual 		Corporate Director
Board President		 Jan 1, 2020
James L Estep
Individual 		Corporate Director
Board Treasurer		 Jan 1, 2020
Sarina Smith
Individual 		Corporate Director Jan 14, 2019
Corporate Director
Board Member		 Jan 14, 2019

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
West Virginia Wesleyan College Wellness Center
Buckhannon, WV · CCN 511146		 Federally qualified health center Operational/Managerial Control (100%) May 21, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20131028001724 WV Part a Provider - Federally Qualified Health Center (FQHC) 0446232987 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Buckhannon, WV
O20131029001913 WV Part a Provider - Federally Qualified Health Center (FQHC) 0446232987 Practice locations: Buckhannon, WV
O20140407000404 WV Part B Supplier - Clinic/Group Practice 0446232987 Receives reassigned benefits from 25 practitioners
Practice locations: Buckhannon, WV

National Provider Directory

Part of
Leading Creek Elem

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 2287-7364 WV Yes

Addresses

Primary practice location

RR 6 Box 303
Buckhannon, WV 26201-8830

Mailing address

PO Box 217
Rock Cave, WV 26234-0217
Phone (304) 924-6262

Other identifiers

IdentifierTypeStateIssuer
2287-7374OtherWVBUSINESS LICENSE

Other names

  • Buckhannon Upshur Middle School Wellness Center Doing business as

Other providers in Buckhannon, WV

All providers in Buckhannon, WV · Federally Qualified Health Center (FQHC) in West Virginia

Sources for this page

Verify at the official NPI Registry.