Braddock Medical Group P.a.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

11172 Issued in WV

Legal business name

BRADDOCK MEDICAL GROUP P.A.

Practice address

70 Presidents Street
Unit 1150
Fort Ashby, WV 26719-1150

Phone

(304) 298-3605

Fax

(304) 298-3578

NPI assigned

Jan 30, 2007

Organization subpart

Yes

Parent organization

BRADDOCK MEDICAL GROUP PAAs reported in NPPES

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

Authorized official

Name

Dr. Paul Taylor Livengood, MD

Title

Owner

Phone

(304) 298-3605

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• Fort Ashby Family Practice Other name

Part of

Braddock Medical Group

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1104962729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 PRESIDENTS STREET",
            "city": "FORT ASHBY",
            "state": "WV",
            "postal_code": "267191150",
            "telephone_number": "304-298-3605",
            "fax_number": "304-298-3578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 PRESIDENTS STREET",
            "address_2": "UNIT 1150",
            "city": "FORT ASHBY",
            "state": "WV",
            "postal_code": "267191150",
            "telephone_number": "304-298-3605",
            "fax_number": "304-298-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADDOCK MEDICAL GROUP P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRADDOCK MEDICAL GROUP PA",
        "enumeration_date": "2007-01-30",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "LIVENGOOD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-298-3605",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "WV",
            "license": "11172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI MDIPA OPTIMUM",
            "identifier": "850-290",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "H529BR",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEDERAL PROVIDER #",
            "identifier": "W399",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "00716943",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "41707101",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000010",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEDERAL GROUP #",
            "identifier": "0003",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056043000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Ashby Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rebekah Lynn Aranda, PT
• Crystal Dawn Arbaugh
• Bedford Road Pharmacy, Inc (The Medicine Shoppe of Fort Ashby)
• Carol Lancaster Bonella, PT
• Tyler Bordick
• Justin Tyler Combs, MSN, APRN, FNP-C
• Complete Care at Dawnview LLC
• Complete Care at Dawnview LLC
• Marcella Ellen Cryser, RPH
• Dawn View Manor, Inc. (Dawn View Center)

• Adult Medicine Physician in Fort Ashby, WV
• Providers in Fort Ashby, WV by specialty
• Adult Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.