NPIMap

Organization Active NPI

Potomac Highlands Guild

  • Community/Behavioral Health Agency
  • Petersburg, WV
National Provider Identifier
1275728628
Registry record updated Sep 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
14000 Issued in WV
Legal business name
POTOMAC HIGHLANDS GUILD
Practice address
6 Park St
Petersburg, WV 26847-1765
Phone
(304) 257-1155
Fax
(304) 257-1945
NPI assigned
Sep 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2007

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

Authorized official

Name
Dr. Frederick S. Raines, MD
Title
Psychiatrist
Phone
(304) 257-1155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 14000 WV Primary

Addresses

Primary practice location

6 Park St
Petersburg, WV 26847-1765

Mailing address

6 Park St
Petersburg, WV 26847-1765
Phone (304) 257-1155

Other identifiers 1

IdentifierTypeStateIssuer
0005473002MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Potomac Highlands Guild6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

53 W Main St
Romney, WV 26757

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189382400000",
    "number": "1275728628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 PARK ST",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471765",
            "telephone_number": "304-257-1155",
            "fax_number": "304-257-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 PARK ST",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471765",
            "telephone_number": "304-257-1155",
            "fax_number": "304-257-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC HIGHLANDS GUILD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-09-10",
        "status": "A",
        "authorized_official_last_name": "RAINES",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "304-257-1155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WV",
            "license": "14000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005473002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; 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.