Active NPI
Billy J Bragg
- Medical Physician Assistant
- Bridgeport, WV
National Provider Identifier
1144376732
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Aug 19, 2010.
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 000554
- Practice address
- 215 W Main St
Bridgeport, WV 26330-1748 - Phone
- (304) 842-6645
- Fax
- (304) 842-4909
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 000554 | WV | Primary |
Addresses
Primary practice location
215 W Main St
Bridgeport, WV 26330-1748
Mailing address
RR 1 Box 359a
Mount Clare, WV 26408-9731
Phone (304) 622-6646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000554 | WV | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1144376732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 1 BOX 359A",
"city": "MOUNT CLARE",
"state": "WV",
"postal_code": "264089731",
"telephone_number": "304-622-6646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 W MAIN ST",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263301748",
"telephone_number": "304-842-6645",
"fax_number": "304-842-4909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAGG",
"first_name": "BILLY",
"middle_name": "J",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WV",
"license": "000554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
- Chad Michael Boram, LPC
- Melissa M Bourgeois, FNP
- Anne Marie Bower, MA
- Kerri C Bowling
- BP WV Maplewood Leasing Co., LLC (Maplewood Healthcare Center)
- Dakota Shawn Bragg
- Rebecca Leeanne Brammer, M.A., CCC-SLP
- Justin Michael Brewer, MMS, ATC, PA-C
- Bridgeport Behavioral Clinic
- Bridgeport Behavioral Medicine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.