Stacy Annette Church, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

01163 Issued in WV

Practice address

3100 Maccorkle Ave SE
Suite 610
Charleston, WV 25304-1223

Phone

(304) 346-1141

Fax

(304) 346-1142

NPI assigned

Aug 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Charleston Area Medical Center, Inc.

  • General Acute Care Hospital
  • Charleston, WV
  • NPI 1124248752

  WV

  Medicare reassignment NPD
• Charleston Area Medical Center Inc

  • Multi-Specialty Clinic/Center
  • Belpre, OH
  • NPI 1588422547
  NPD
• Charleston Area Medical Center Inc

  • Psychiatric Hospital Unit
  • Charleston, WV
  • NPI 1265421226
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1114930658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE",
            "address_2": "SUITE 610",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041223",
            "telephone_number": "304-346-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE",
            "address_2": "SUITE 610",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041223",
            "telephone_number": "304-346-1141",
            "fax_number": "304-346-1142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "STACY",
        "middle_name": "ANNETTE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christy Robinson Capital City Pediatrics
• Katherine Chufandama
• Kelly A Chura-Singh, D.O.
• Pamela Church
• Shelby Church
• Wanda Church
• Selena Chustz
• Vicki Cielensky-Holstein
• Lauren Michelle Cieslinski
• Shayla Cincinnati

• All providers in Charleston, WV
• Medical Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.