NPIMap

Individual provider Active NPI

Philip Todd Berry, DO

  • Family Medicine Physician
  • Scarbro, WV
National Provider Identifier
1194943522
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2120 Issued in WV
Practice address
RR 2 Box 615a
Scarbro, WV 25917-9784
Phone
(304) 388-2525
Fax
(304) 388-2537
NPI assigned
Apr 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2120 WV Primary
Family Medicine Physician 207Q00000X 34.012389 OH

Addresses

Primary practice location

RR 2 Box 615a
Scarbro, WV 25917-9784

Mailing address

RR 2 Box 615a
Scarbro, WV 25917-9784
Phone (304) 388-2525

Other identifiers 2

IdentifierTypeStateIssuer
0181970MedicaidOH
3810010455MedicaidWV

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
I20080206000379 WV Practitioner - Family Practice 7416030093 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boone Memorial Hospital IncGroup PAC ID 3375433352, 78 clinicians

Practice addresses (Care Compare)

701 Madison Ave
Madison, WV 25130-1669
Phone (304) 369-1230

Hospital & facility affiliations

  • Boone Memorial Hospital Hospital, Madison, WV, CCN 511313
  • Boone Memorial Hospital Nursing home, CCN 51Z313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34.012389OHMDFamily Medicine Physician
2120WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boone Memorial Hospital, Inc Family Medicine Current Accepting new patients
Scott Keffer Inc Family Medicine CurrentSince Feb 8, 2013 Accepting new patients
Boone Memorial Hospital, Inc Current Accepting new patients
Boone Memorial Hospital, Inc CurrentSince Nov 1, 2018 Accepting new patients
Boone Memorial Hospital, Inc Family Medicine CurrentSince Nov 1, 2018 Accepting new patients
New River Health Association, Inc. Past Accepting new patients
Greenbrier Emergency Services, Inc. Past Accepting new patients
Community Health Association Past Accepting new patients
New River Health Association, Inc. Past Accepting new patients

Locations

6952 Coal River Rd
#C
Comfort, WV 25049
Phone (304) 307-3116

701 Madison Ave
Madison, WV 25130
Phone (304) 369-1230

Organizations & group practices 13

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.

View all 13

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": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1194943522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 615A",
            "city": "SCARBRO",
            "state": "WV",
            "postal_code": "259179784",
            "telephone_number": "304-388-2525",
            "fax_number": "304-388-2537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 615A",
            "city": "SCARBRO",
            "state": "WV",
            "postal_code": "259179784",
            "telephone_number": "304-388-2525",
            "fax_number": "304-388-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "PHILIP",
        "middle_name": "TODD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "2120",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.012389",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0181970",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810010455",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scarbro, WV

Sources for this page

Verify at the official NPI Registry.