NPIMap

Organization Active NPI

Princeton Audiology Clinic, Inc.,

Doing business as dba Blue Ridge Hearing and Balance Clinic

  • Hearing Aid Equipment
  • Princeton, WV
National Provider Identifier
1073580817
Registry record updated Jun 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Aid EquipmentTaxonomy code 332S00000X
Legal business name
PRINCETON AUDIOLOGY CLINIC, INC.,
Doing business as
dba Blue Ridge Hearing and Balance Clinic
Practice address
508 New Hope Road
Suite #19
Princeton, WV 24740-2272
Phone
(304) 487-2487
Fax
(304) 431-3367
NPI assigned
Mar 1, 2006
Last updated
Jun 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2013

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

Authorized official

Name
Alan Louis Desmond, AUD., CCC-ANPI 1275501439
Title
President
Phone
(304) 487-2487

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU
Speech-Language Pathologist 235Z00000X NU
Hearing Aid Equipment 332S00000X NU Primary

Addresses

Primary practice location

508 New Hope Road
Suite #19
Princeton, WV 24740-2272

Mailing address

508 New Hope Road
Suite #19
Princeton, WV 24740-2272
Phone (304) 487-2487

Other identifiers 6

IdentifierTypeStateIssuer
3810002482MedicaidWV
4250000-000MedicaidWV
PR9319051OtherPALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE
PR9319052OtherPALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE
CC3775OtherPALMETTO GBA RR MEDICARE
4250000000MedicaidWV

Other names 1

  • dba Blue Ridge Hearing and Balance Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040511001102 WV Part B Supplier - Clinic/Group Practice 1052300357 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Princeton, WV

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

508 New Hope Rd
Ste 19
Princeton, WV 24740
Phone (304) 487-2487

Practitioners & affiliated clinicians

Practitioners 12

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": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1073580817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 NEW HOPE ROAD",
            "address_2": "SUITE #19",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402272",
            "telephone_number": "304-487-2487",
            "fax_number": "304-431-3367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 NEW HOPE ROAD",
            "address_2": "SUITE #19",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402272",
            "telephone_number": "304-487-2487",
            "fax_number": "304-431-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCETON AUDIOLOGY CLINIC, INC.,",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "DESMOND",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-487-2487",
        "authorized_official_credential": "AUD., CCC-A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002482",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4250000-000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA MEDICARE PTAN NUMBER PCTN OFFICE",
            "identifier": "PR9319051",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA MEDICARE PTAN NUMBER BLFD OFFICE",
            "identifier": "PR9319052",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RR MEDICARE",
            "identifier": "CC3775",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4250000000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Blue Ridge Hearing and Balance Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.