NPIMap

Organization Active NPI

Monroe County Health Center Board of Trustees

Doing business as Monroe Health Center

  • Federally Qualified Health Center (FQHC)
  • Union, WV
National Provider Identifier
1992734487
Registry record updated Feb 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Doing business as
Monroe Health Center
Practice address
200 Health Center Drive
Union, WV 24983
Phone
(304) 772-3064
Fax
(304) 772-3296
NPI assigned
Jun 30, 2006
Last updated
Feb 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2011

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

Authorized official

Name
Mrs. Shannon Parker, MBA
Title
Ceo
Phone
(304) 772-3064

Specialties & licenses 1

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

Addresses

Primary practice location

200 Health Center Drive
Union, WV 24983

Mailing address

200 Health Center Drive
PO Box 590
Union, WV 24983
Phone (304) 772-3064

Other identifiers 4

IdentifierTypeStateIssuer
0035243000MedicaidWV
5611053OtherWVAETNA
001706775OtherWVBC/BS
DB2513OtherWVMEDICARE RR GROUP

Other names 1

  • Monroe Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040330001675 WV Part B Supplier - Public Health/Welfare Agency 3173432671 Receives reassigned benefits from 29 practitioners
5 other NPIs on this enrollment
Practice locations: Union, WV; Peterstown, WV; Lindside, WV; Forest Hill, WV
O20110302000425 WV Part A Provider - Federally Qualified Health Center (FQHC) 3173432671 Practice locations: Union, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992734487. Details of each certification follow.

Federally qualified health center certification: CCN 511837

Legal name
MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES
Doing business as
MONROE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1993
Last certification
Jul 1, 1993
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 2006 in WV
Enrollment address
200 Health Center Drive
Union, WV 24983-0590

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

Other NPIs with the same Medicare PAC ID 7

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

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

Locations

200 Health Center Dr
Union, WV 24983
Phone (304) 772-3064

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Salvatore Bellassai Individual Corporate Director Jul 27, 2022
James Holtman Individual Corporate Director Sep 1, 2017
Richard Miller Individual Corporate Director Dec 1, 2020
James Nelson Individual Corporate DirectorCeo Dec 1, 2014
Vaden R Tabor Individual Corporate Director May 1, 2018
Wayne D Spangler Individual Corporate Director Dec 30, 2007
Scott King Individual Corporate Director Aug 25, 2021
Shirley H Dixon Individual Corporate Director Dec 30, 2007
Amy Mann Individual Corporate Director Apr 1, 2018
Monroe County Health Center Board of Trustees Organization, Union, WV Non-profit Operational/Managerial Control Jun 30, 2006 100%
Walter Marsden Individual Corporate Director Jan 1, 2011
Janet W Caulkins Individual Corporate Director Dec 30, 2007
Michelle Ballard Individual Corporate DirectorCoo Dec 30, 2007
W-2 Managing EmployeeCoo Dec 30, 2007
Jeffry a Pritt Individual Corporate Director Dec 30, 2007
Melissa F Boggs Individual Corporate Director Dec 30, 2007

Owners & managing parties with NPI records 7

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
Craig County Health CenterNew Castle, VA, CCN 491881 Federally qualified health center Operational/Managerial Control (100%) Aug 30, 2007

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297296000000",
    "number": "1992734487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HEALTH CENTER DRIVE",
            "address_2": "PO BOX 590",
            "city": "UNION",
            "state": "WV",
            "postal_code": "24983",
            "telephone_number": "304-772-3064",
            "fax_number": "304-772-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTH CENTER DRIVE",
            "city": "UNION",
            "state": "WV",
            "postal_code": "24983",
            "telephone_number": "304-772-3064",
            "fax_number": "304-772-3296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONROE COUNTY HEALTH CENTER BOARD OF TRUSTEES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-02-10",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-772-3064",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035243000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5611053",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "001706775",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR GROUP",
            "identifier": "DB2513",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union, WV

Sources for this page

Verify at the official NPI Registry.