Active NPI
Nicolas Harris, MD
- Emergency Medicine Physician
- Charleston, WV
National Provider Identifier
1124718663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 36437
- Practice address
- 3200 Maccorkle Ave SE
Charleston, WV 25304-1227 - Phone
- (304) 388-5432
- NPI assigned
- May 9, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 36437 | WV | Primary |
Addresses
Primary practice location
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Mailing address
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone (860) 333-4172
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124718663 | Medicaid | WV |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230807002624 | WV | Order and Referring Only - Emergency Medicine | 8426419466 |
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
400 Association Dr
Suite 102
Charleston, WV 25311-1295
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785715200000",
"number": "1124718663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "860-333-4172",
"fax_number": "304-388-4155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "304-388-5432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "NICOLAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-09",
"last_updated": "2026-08-03",
"certification_date": "2026-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WV",
"license": "36437",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1124718663",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; 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.
- 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.