NPIMap

Individual provider Active NPI

Melanie Bagshaw Takubo, PA-C

  • Physician Assistant
  • Charleston, WV
National Provider Identifier
1124837257
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
842 Issued in WV
Practice address
3100 Maccorkle Ave SE Ste 902
Charleston, WV 25304-1234
Phone
(304) 388-6590
NPI assigned
Jan 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 842 WV Primary

Addresses

Primary practice location

3100 Maccorkle Ave SE Ste 902
Charleston, WV 25304-1234

Mailing address

119 Angel Ter
Charleston, WV 25314-2116
Phone (304) 989-5858

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
I20250228002362 WV Practitioner - Physician Assistant 7113447509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3100 Maccorkle Ave SE
Charleston, WV 25304-1223

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Feb 17, 2025 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Feb 17, 2025 Accepting new patients

Locations

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

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

3100 Maccorkle Ave SE
Ste 902
Charleston, WV 25304
Phone (304) 388-0205

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1735862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1124837257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 ANGEL TER",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253142116",
            "telephone_number": "304-989-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 902",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041234",
            "telephone_number": "304-388-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKUBO",
        "first_name": "MELANIE",
        "middle_name": "BAGSHAW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-03",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.