NPIMap

Organization Active NPI

Shenandoah Valley Medical System,Inc.

  • Federally Qualified Health Center (FQHC)
  • Charles Town, WV
National Provider Identifier
1992904668
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHENANDOAH VALLEY MEDICAL SYSTEM,INC.
Practice address
44 Trifecta PL Ste 205
Charles Town, WV 25414-5720
Phone
(304) 728-3716
Fax
(304) 278-3740
NPI assigned
Jul 13, 2007
Last updated
Apr 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Authorized official

Name
Michael Hassing
Title
Ceo
Phone
(304) 263-4999

Specialties & licenses 1

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

Addresses

Primary practice location

44 Trifecta PL Ste 205
Charles Town, WV 25414-5720

Mailing address

PO Box 1146
Martinsburg, WV 25402-1146
Phone (304) 263-4999

Other identifiers 1

IdentifierTypeStateIssuer
3810008360MedicaidWV

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000556 WV Part B Supplier - Public Health/Welfare Agency 9739093097 Receives reassigned benefits from 34 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berkeley Springs, WV; Charles Town, WV; Martinsburg, WV; Ranson, WV
O20051229000496 WV Part A Provider - Federally Qualified Health Center (FQHC) 9739093097 Practice locations: Charles Town, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992904668. Details of each certification follow.

Federally qualified health center certification: CCN 511905

Legal name
SHENANDOAH VALLEY MEDICAL SYSTEM,INC.
Doing business as
SHENANDOAH COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 5, 2006
Last certification
Apr 5, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 7, 1976 in WV
Enrollment address
44 Trifecta PL
Ste 205
Charles Town, WV 25414-5720

Other NPIs with the same Medicare PAC ID 10

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.

National Provider Directory

National Provider Directory
Tax ID family
Shenandoah Valley Medical Systeminc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Annley Nikki Bigiarelli Individual Corporate DirectorBoard of Directors Dec 5, 2022
John Charlton Individual Corporate OfficerSecretary Apr 3, 2023
Corporate DirectorBoard Member Mar 1, 2000
Harold Shrewsberry Individual Corporate OfficerChairman of the Board Apr 3, 2023
Frank S Coe Individual Corporate OfficerTreasurer Jan 4, 2021
Corporate DirectorBoard Member Aug 1, 2002
Todd M Lockcuff Individual Corporate OfficerCeo Sep 1, 2025 100%
W-2 Managing EmployeeCeo Sep 1, 2025
Zachary Leach Individual Corporate OfficerVice Chair Nov 6, 2023

Practitioners & affiliated clinicians

Practitioners 9

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": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744329600000",
    "number": "1992904668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1146",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254021146",
            "telephone_number": "304-263-4999",
            "fax_number": "304-263-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 TRIFECTA PL STE 205",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254145720",
            "telephone_number": "304-728-3716",
            "fax_number": "304-278-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHENANDOAH VALLEY MEDICAL SYSTEM,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A",
        "authorized_official_last_name": "HASSING",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-263-4999"
    },
    "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": "3810008360",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charles Town, WV

Sources for this page

Verify at the official NPI Registry.