NPIMap

Organization Active NPI

Neurology & Headache Clinic PLLC

  • Neurology Physician
  • Charleston, WV
National Provider Identifier
1336185164
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
21117 Issued in WV
Legal business name
NEUROLOGY & HEADACHE CLINIC PLLC
Practice address
3100 Maccorkle Ave SE
Suite 802
Charleston, WV 25304
Phone
(304) 343-4400
Fax
(304) 345-5005
NPI assigned
Jun 21, 2006
Last updated
Jan 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2018

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

Authorized official

Name
Darshankumar Ashwinbhai Dave, MDNPI 1033155437
Title
Owner
Phone
(304) 343-4400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 21117 WV Primary

Addresses

Primary practice location

3100 Maccorkle Ave SE
Suite 802
Charleston, WV 25304

Mailing address

3100 Maccorkle Ave SE Ste 411
Charleston, WV 25304-1230
Phone (304) 343-4400

Other identifiers 1

IdentifierTypeStateIssuer
1841796000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091231000193 WV Part B Supplier - Clinic/Group Practice 4688715451 Receives reassigned benefits from 15 practitioners
Practice locations: Charleston, WV

National Provider Directory

National Provider Directory

Locations

3100 Maccorkle Ave SE
Ste 802
Charleston, WV 25304
Phone (304) 343-4400

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CEFFAA

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516924800000",
    "number": "1336185164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 411",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041230",
            "telephone_number": "304-343-4400",
            "fax_number": "304-345-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE",
            "address_2": "SUITE 802",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "25304",
            "telephone_number": "304-343-4400",
            "fax_number": "304-345-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGY & HEADACHE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2018-01-26",
        "status": "A",
        "authorized_official_last_name": "DAVE",
        "authorized_official_first_name": "DARSHANKUMAR",
        "authorized_official_middle_name": "ASHWINBHAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-343-4400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WV",
            "license": "21117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841796000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.