Individual provider Active NPI

Caleb Jonathon McDonald, FNP-C

  • Primary Care Nurse Practitioner
  • Princeton, WV
National Provider Identifier
1063289171
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
117814 Issued in WV
Practice address
118TH Twelfth Street
Princeton, WV 24740
Phone
(304) 487-7936
NPI assigned
Dec 8, 2023
Last updated
Dec 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 117814 WV Primary

Addresses

Primary practice location

118TH Twelfth Street
Princeton, WV 24740

Mailing address

118 Twelfth Street
Princeton, WV 24740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240327000772 WV Practitioner - Nurse Practitioner 6709223639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

118 12TH St
Princeton, WV 24740-2312
Phone (304) 487-7936

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
117814WVMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Princeton Community Hospital Assn Inc. CurrentSince Feb 9, 2024 Accepting new patients
Princeton Community Hospital Assn., Inc CurrentSince Feb 9, 2024 Accepting new patients

Locations

401 E Vermillion St
Athens, WV 24712
Phone (304) 384-7325

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1701993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1063289171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 TWELFTH STREET",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118TH TWELFTH STREET",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-487-7936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "CALEB",
        "middle_name": "JONATHON",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-08",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WV",
            "license": "117814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

Verify at the official NPI Registry.