NPIMap

Organization Active NPI

Bruceton Family Medicine LLC

  • Family Medicine Physician
  • Bruceton Mills, WV
National Provider Identifier
1295228161
Registry record updated Jul 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
52464 Issued in WV
Legal business name
BRUCETON FAMILY MEDICINE LLC
Practice address
198 Morgantown St Ste 2
Bruceton Mills, WV 26525
Phone
(304) 379-7600
Fax
(304) 379-7599
NPI assigned
Jun 14, 2018
Last updated
Jul 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2018

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

Authorized official

Name
Mrs. Alysia Funk, APRN,FNP-BCNPI 1861742629
Title
Owner/Nurse Practitioner
Phone
(304) 379-7600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 81124 WV
Family Medicine Physician 207Q00000X 52464 WV Primary

Addresses

Primary practice location

198 Morgantown St Ste 2
Bruceton Mills, WV 26525

Mailing address

PO Box 442
Bruceton Mills, WV 26525-0442
Phone (304) 379-7600

Other identifiers 1

IdentifierTypeStateIssuer
3810029631MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1295228161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 442",
            "city": "BRUCETON MILLS",
            "state": "WV",
            "postal_code": "265250442",
            "telephone_number": "304-379-7600",
            "fax_number": "304-379-7599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 MORGANTOWN ST STE 2",
            "city": "BRUCETON MILLS",
            "state": "WV",
            "postal_code": "26525",
            "telephone_number": "304-379-7600",
            "fax_number": "304-379-7599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCETON FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-14",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "FUNK",
        "authorized_official_first_name": "ALYSIA",
        "authorized_official_title_or_position": "OWNER/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "304-379-7600",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN,FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "81124",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "52464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810029631",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bruceton Mills, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.