Individual provider Active NPI

Andyara Euzebio Passos, PA-C

  • Physician Assistant
  • South Charleston, WV
National Provider Identifier
1194419994
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2742 Issued in WV
Practice address
4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone
(304) 766-3600
NPI assigned
Jun 5, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2742 WV
Physician Assistant 363A00000X 2742 WV Primary

Addresses

Primary practice location

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311

Mailing address

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 766-3600

Other practice location 1

1320 Maplewood Ave
Ronceverte, WV 24970-8016
Phone (304) 647-4411

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230908002503 WV Practitioner - Physician Assistant 9234593229 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2742WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Princeton Community Hospital Assn Inc. CurrentSince Dec 15, 2025 Accepting new patients
West Virginia Health Care Cooperative Inc Physician Assistant CurrentSince Dec 9, 2025 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jul 26, 2023 Accepting new patients
Camc Greenbrier Valley Medical Center Inc CurrentSince May 1, 2024 Accepting new patients
West Virginia Health Care Cooperative Inc CurrentSince Dec 9, 2025 Accepting new patients
Camden-Clark Physician Corporation CurrentSince Dec 11, 2025 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Jul 26, 2023 Accepting new patients
Princeton Community Hospital Assn., Inc CurrentSince Dec 15, 2025 Accepting new patients
Camc Greenbrier Valley Medical Center, Inc. CurrentSince May 1, 2024 Accepting new patients
Princeton Community Hospital Assn. Inc. Past Accepting new patients

Locations

401 E Vermillion St
Athens, WV 24712
Phone (304) 384-7325

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

800 Garfield Ave
Parkersburg, WV 26101
Phone (304) 420-7161

800 Garfield Ave
Rm G101
Parkersburg, WV 26101
Phone (304) 422-0405

122 12th St
Princeton, WV 24740
Phone (304) 487-7061

1521 Maplewood Ave
Ronceverte, WV 24970

1320 Maplewood Ave
Ronceverte, WV 24970
Phone (304) 645-0870

400 Fairview Heights Rd
Summersville, WV 26651
Phone (304) 872-2891

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1194419994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-766-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-766-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 Maplewood Ave",
            "address_purpose": "LOCATION",
            "city": "Ronceverte",
            "state": "WV",
            "postal_code": "249708016",
            "country_code": "US",
            "telephone_number": "304-647-4411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSOS",
        "first_name": "ANDYARA",
        "middle_name": "EUZEBIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-05",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "2742",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.