Active NPI
Jack R Traylor, MD
- Surgery Physician
- Huntington, WV
National Provider Identifier
1174582456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 12969
- Practice address
- 1400 Hal Greer Boulevard
Huntington, WV 25701-3656 - Phone
- (304) 399-6609
- Fax
- (304) 399-6621
- NPI assigned
- Mar 23, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 12969 | WV | Primary |
Addresses
Primary practice location
1400 Hal Greer Boulevard
Huntington, WV 25701-3656
Mailing address
1400 Hal Greer Boulevard
Huntington, WV 25701-3656
Phone (304) 399-6556
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0128350000 | Medicaid | WV | |
| 64694771 | Medicaid | KY | |
| 0491258 | Medicaid | OH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jack.traylor@marshall.cernerdirect.com |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- jack.traylor@chhi.direct.varian.com
- jack.traylor@marshall.cernerdirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1174582456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 HAL GREER BOULEVARD",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257013656",
"telephone_number": "304-399-6556",
"fax_number": "304-399-6554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 HAL GREER BOULEVARD",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257013656",
"telephone_number": "304-399-6609",
"fax_number": "304-399-6621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAYLOR",
"first_name": "JACK",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2021-05-03",
"certification_date": "2021-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WV",
"license": "12969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0128350000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64694771",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0491258",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jack.traylor@marshall.cernerdirect.com",
"affiliation": "N",
"address_1": "1400 Hal Greer Boulevard",
"city": "Huntington",
"state": "WV",
"country_code": "US",
"postal_code": "257013656",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Huntington, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.