Blue Lot MD PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BLUE LOT MD PLLC

Practice address

10 Courtney Dr
Charleston, WV 25304-2699

Phone

(304) 344-2345

Fax

(304) 400-4645

NPI assigned

Jul 7, 2022

Organization subpart

Yes

Parent organization

BLUE LOT MD PLLCAs reported in NPPES

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

Authorized official

Name

Dr. Letitia Elaine Tierney, MDNPI 1679792493

Title

Sole Member

Phone

(304) 344-2345

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Letitia Tierney Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Blue Lot MD PLLC

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Letitia Elaine Tierney, MD

  • Internal Medicine Physician
  • Charleston, WV
  • NPI 1679792493
  Medicare reassignment NPD Authorized official
• Reginald Jay McClung, MD

  • Family Medicine Physician
  • Charleston, WV
  • NPI 1497831879
  NPD (past)

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1104559160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 COURTNEY DR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042699",
            "telephone_number": "304-344-2345",
            "fax_number": "304-400-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 COURTNEY DR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042699",
            "telephone_number": "304-344-2345",
            "fax_number": "304-400-4645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "331 Laidley St Ste 205",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011605",
            "country_code": "US",
            "telephone_number": "304-344-2345",
            "fax_number": "304-400-4645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE LOT MD PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLUE LOT MD PLLC",
        "enumeration_date": "2022-07-07",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "TIERNEY",
        "authorized_official_first_name": "LETITIA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "304-344-2345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810017636",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Letitia Tierney",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Letitia Tierney",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stewart H Bloom, GENERAL DENTIST
• Valarie Bloom, FNP-BC
• Blossom Therapy Services LLC
• Paula Blount, PA
• Tonia Blount, PRSS
• Pamela Hines Blue, LPC
• Joseph Michael Blumer, D.O.
• Steven Bly
• Meghan Nicole Board
• Carla Boardman, RN

• Internal Medicine Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Internal Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.