Individual provider Active NPI

Melody Ponce', FNP-C

  • Family Nurse Practitioner
  • Princeton, WV
National Provider Identifier
1366748980
Registry record updated Feb 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
74209 Issued in WV
Practice address
405 12TH Street Ext
Princeton, WV 24740-2300
Phone
(304) 425-7243
Fax
(304) 487-3525
NPI assigned
Jan 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 74209 WV Primary

Addresses

Primary practice location

405 12TH Street Ext
Princeton, WV 24740-2300

Mailing address

405 12TH Street Ext
Princeton, WV 24740-2300
Phone (304) 425-7243

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110405001089 WV Practitioner - Nurse Practitioner 1951585538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bluefield Gastroenterology PLLCGroup PAC ID 5799776738, 6 clinicians

Practice addresses (Care Compare)

405 12TH St Ext
Princeton, WV 24740-2300
Phone 30442572431105

Hospital & facility affiliations

  • Princeton Community Hospital Assn Inc Hospital, Princeton, WV, CCN 510046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
74209WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bluefield Gastroenterology PLLC CurrentSince Feb 28, 2011 Accepting new patients
Mountain Medical Clinic PC Past Accepting new patients

Locations

144 Seddon St
Bland, VA 24315
Phone (276) 688-4800

405 12th Street Ext
Princeton, WV 24740
Phone (304) 324-2733

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1296172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297728000000",
    "number": "1366748980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 12TH STREET EXT",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402300",
            "telephone_number": "304-425-7243",
            "fax_number": "304-487-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 12TH STREET EXT",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402300",
            "telephone_number": "304-425-7243",
            "fax_number": "304-487-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE'",
        "first_name": "MELODY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-28",
        "last_updated": "2011-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "74209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

Verify at the official NPI Registry.