Active NPI
Antonio R Diaz Jr., M.D.
- Psychiatry Physician
- Logan, WV
National Provider Identifier
1053339135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 16814
- Practice address
- 174 Lmah Center Rd
Logan, WV 25601-4058 - Phone
- (304) 792-7130
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 16814 | WV | Primary |
Addresses
Primary practice location
174 Lmah Center Rd
Logan, WV 25601-4058
Mailing address
PO Box 176
Logan, WV 25601-0176
Phone (304) 792-7130
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0288291 | Medicaid | OH | |
| 1493983 | Other | WV | UMWA |
| 550751751 | Other | WV | BLUE CROSS/BLUE SHIELD |
| 64940489 | Medicaid | KY | |
| 000706447 | Other | BLUE CROSS/BLUE SHIELD | |
| 0115148000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- https://api.platform.athenahealth.com/21756/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629331200000",
"number": "1053339135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 176",
"city": "LOGAN",
"state": "WV",
"postal_code": "256010176",
"telephone_number": "304-792-7130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 LMAH CENTER RD",
"city": "LOGAN",
"state": "WV",
"postal_code": "256014058",
"telephone_number": "304-792-7130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "ANTONIO",
"middle_name": "R",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2021-08-19",
"certification_date": "2021-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WV",
"license": "16814",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0288291",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1493983",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "550751751",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64940489",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "000706447",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0115148000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Logan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.