NPIMap

Individual provider Active NPI

Stephen Derrick Eddy, MD

  • Sports Medicine (Internal Medicine) Physician
  • Wheeling, WV
National Provider Identifier
1255351201
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
License
35084571 Issued in OH
Practice address
30 Medical Park
Suite 201
Wheeling, WV 26003-6391
Phone
(304) 243-8630
Fax
(304) 243-8575
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Internal Medicine) Physician 207RS0010X 35084571 OH Primary
Sports Medicine (Internal Medicine) Physician 207RS0010X PA MD429317 PA

Addresses

Primary practice location

30 Medical Park
Suite 201
Wheeling, WV 26003-6391

Mailing address

30 Medical Park
Suite 201
Wheeling, WV 26003-6391
Phone (304) 243-8630

Other identifiers 5

IdentifierTypeStateIssuer
P00469047OtherPARR MEDICARE
0018294730001MedicaidPA
2679632MedicaidOH
3810006366MedicaidWV
P00428195OtherOHMEDICARE RAILROAD

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

State licenses

LicenseStateTypeSpecialty
PA MD429317PAMDSports Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Akron Children'S Hospital Current Accepting new patients
Wheeling Hospital, Inc. Past Accepting new patients
Children'S Hospital Medical Center of Akron Past Accepting new patients
Riverside Medical Inc. Past Accepting new patients
Riverside Medical Inc Sports Medicine Past Accepting new patients
Children'S Hospital Medical Center of Akron Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: seddy53024@direct.chmca.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1255351201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MEDICAL PARK",
            "address_2": "SUITE 201",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036391",
            "telephone_number": "304-243-8630",
            "fax_number": "304-243-8575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MEDICAL PARK",
            "address_2": "SUITE 201",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036391",
            "telephone_number": "304-243-8630",
            "fax_number": "304-243-8575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDY",
        "first_name": "STEPHEN",
        "middle_name": "DERRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "OH",
            "license": "35084571",
            "primary": true
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "PA",
            "license": "PA MD429317",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00469047",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018294730001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2679632",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006366",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00428195",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.