Individual provider Active NPI

John A Wade Jr., MD

  • Otolaryngology Physician
  • Point Pleasant, WV
National Provider Identifier
1215066873
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
WV10321 Issued in WV
Practice address
2414 Jefferson Ave
Point Pleasant, WV 25550-1528
Phone
(304) 675-1244
Fax
(304) 675-1245
NPI assigned
Mar 2, 2007
Last updated
May 26, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X WV10321 WV
Otolaryngology Physician 207Y00000X WV10321 WV Primary

Addresses

Primary practice location

2414 Jefferson Ave
Point Pleasant, WV 25550-1528

Mailing address

2414 Jefferson Ave
Point Pleasant, WV 25550-1528
Phone (304) 675-1244

Other identifiers 3

IdentifierTypeStateIssuer
0101405000MedicaidWV
0363655MedicaidOH
001719894OtherWVBLUE CROSS BLUE SHIELD

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081202000360 WV Practitioner - OtolaryngologyPractitioner - Allergy/Immunology 2860553435

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
WV10321WVMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Point Pleasant Physician Billing Services CurrentSince Jul 1, 2010 Accepting new patients
Community Health Association Past Accepting new patients

Locations

2520 Valley Dr
Ste 112
Point Pleasant, WV 25550
Phone (304) 553-3364

2414 Jefferson Ave
Pt Pleasant, WV 25550
Phone (304) 675-1244

2520 Valley Dr
Ste 113
Pt Pleasant, WV 25550
Phone (304) 675-1020

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1215066873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414 JEFFERSON AVE",
            "city": "POINT PLEASANT",
            "state": "WV",
            "postal_code": "255501528",
            "telephone_number": "304-675-1244",
            "fax_number": "304-675-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2414 JEFFERSON AVE",
            "city": "POINT PLEASANT",
            "state": "WV",
            "postal_code": "255501528",
            "telephone_number": "304-675-1244",
            "fax_number": "304-675-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "WV",
            "license": "WV10321",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WV",
            "license": "WV10321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0101405000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0363655",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001719894",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Point Pleasant, WV

Sources for this page

Verify at the official NPI Registry.