NPIMap

Individual provider Active NPI

Kelby Lyn Faulkiner, DO

  • Family Medicine Physician
  • Buckeye, WV
National Provider Identifier
1124005160
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1954 Issued in WV
Practice address
150 Duncan Rd
Buckeye, WV 24924-9037
Phone
(304) 799-7400
Fax
(304) 799-2276
NPI assigned
Dec 30, 2005
Last updated
May 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1954 WV Primary

Addresses

Primary practice location

150 Duncan Rd
Buckeye, WV 24924-9037

Mailing address

150 Duncan Rd
Buckeye, WV 24924-9037
Phone (304) 799-7400

Other identifiers 1

IdentifierTypeStateIssuer
3810001514MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050111000549 WV Practitioner - Emergency MedicinePractitioner - Family Practice 9436107976 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pocahontas Memorial HospitalGroup PAC ID 9234100645, 15 clinicians

Practice addresses (Care Compare)

150 Duncan Rd
Buckeye, WV 24924-9037
Phone (304) 799-7400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1954WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. Current Accepting new patients
Charleston Area Medical Center Inc CurrentSince Jun 25, 2021 Accepting new patients
Pocahontas Memorial Hospital CurrentSince Mar 22, 2016 Accepting new patients
Pocahontas Memorial Hospital Current Accepting new patients
Oak Hill Emergency Physicians, LLC CurrentSince Mar 1, 2014 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jun 25, 2021 Accepting new patients
Stillwell Road Operations LLC Past Accepting new patients
BJSM Med Inc Past Accepting new patients
Greenbrier Valley Emergency Physicians LLC Past Accepting new patients

Locations

150 Duncan Rd
Buckeye, WV 24924
Phone (304) 799-7400

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

430 Main St W
Oak Hill, WV 25901
Phone (276) 325-0678

1320 Maplewood Ave
Ronceverte, WV 24970
Phone (304) 645-0870

Interoperability endpoints

  • Direct secure messaging: klfaulki@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pocahontas Memorial HospitalBuckeye, WV, CCN 51Z314 Hospital Corporate Officer May 1, 2021
Pocahontas Memorial HospitalBuckeye, WV, CCN 511314 Hospital Corporate Officer May 1, 2021
Pocahontas CenterMarlinton, WV, CCN 515183 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2021
Jul 1, 2021
Pocahontas Memorial Hospital Medical Practice RHCBuckeye, WV, CCN 513415 Rural health clinic Corporate Officer May 1, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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 3

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": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1124005160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 DUNCAN RD",
            "city": "BUCKEYE",
            "state": "WV",
            "postal_code": "249249037",
            "telephone_number": "304-799-7400",
            "fax_number": "304-799-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 DUNCAN RD",
            "city": "BUCKEYE",
            "state": "WV",
            "postal_code": "249249037",
            "telephone_number": "304-799-7400",
            "fax_number": "304-799-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAULKINER",
        "first_name": "KELBY",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001514",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckeye, WV

Sources for this page

Verify at the official NPI Registry.