Individual provider Active NPI

Stephen Michael Patrick, PA-C

  • Surgical Physician Assistant
  • Glen Dale, WV
National Provider Identifier
1124109533
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
01098 Issued in WV
Practice address
800 Wheeling Ave
Glen Dale, WV 26038-1660
Phone
(304) 845-3211
NPI assigned
Oct 19, 2006
Last updated
Apr 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 01098 WV
Surgical Physician Assistant 363AS0400X 01098 WV Primary

Addresses

Primary practice location

800 Wheeling Ave
Glen Dale, WV 26038-1660

Mailing address

107 Remington Dr
Wheeling, WV 26003-9402
Phone (304) 281-0462

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041025001056 WV Practitioner - Physician Assistant 3274594999 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reynolds Memorial Hospital, IncGroup PAC ID 9830184530, 152 clinicians

Practice addresses (Care Compare)

800 Wheeling Ave
Glen Dale, WV 26038-1660
Phone (304) 843-3307

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1098WVMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Reynolds Memorial Hospital, Inc. CurrentSince Nov 1, 2019 Accepting new patients
Reynolds Memorial Hospital, Inc CurrentSince Nov 1, 2019 Accepting new patients

Locations

90 N 4th St
Martins Ferry, OH 43935
Phone (304) 234-8425

800 Wheeling Ave
Glen Dale, WV 26038
Phone (304) 221-4520

2000 Eoff St
Wheeling, WV 26003
Phone (304) 234-0123

2000 Eoff St
#602
Wheeling, WV 26003
Phone (304) 242-8027

Organizations & group practices 2

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": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1124109533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 REMINGTON DR",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260039402",
            "telephone_number": "304-281-0462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WHEELING AVE",
            "city": "GLEN DALE",
            "state": "WV",
            "postal_code": "260381660",
            "telephone_number": "304-845-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "STEPHEN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01098",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WV",
            "license": "01098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Dale, WV

Sources for this page

Verify at the official NPI Registry.