NPIMap

Individual provider Active NPI

Bryan S Stafford, PA C

  • Family Medicine Physician
  • Beckley, WV
National Provider Identifier
1154412435
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
197 Issued in WV
Practice address
415 Carriage Drive
Beckley, WV 25801
Phone
(304) 732-6735
Fax
(304) 732-9218
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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 197 WV Primary

Addresses

Primary practice location

415 Carriage Drive
Beckley, WV 25801

Mailing address

415 Carriage Drive
Beckley, WV 25801
Phone (304) 732-6735

Other identifiers 1

IdentifierTypeStateIssuer
3810000500MedicaidWV

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
I20100209000046 WV Practitioner - Physician Assistant 6800939158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern West Virginia Primary Care IncGroup PAC ID 9830408376, 4 clinicians

Practice addresses (Care Compare)

415 Carriage Dr
Beckley, WV 25801-2805
Phone (304) 250-0142

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
668WVMDAnesthesiology Physician

Organizations & group practices 1

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 12

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1154412435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 CARRIAGE DRIVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "25801",
            "telephone_number": "304-732-6735",
            "fax_number": "304-732-9218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 CARRIAGE DRIVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "25801",
            "telephone_number": "304-732-6735",
            "fax_number": "304-732-9218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "BRYAN",
        "middle_name": "S",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000500",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beckley, WV

Sources for this page

Verify at the official NPI Registry.