Donald Ta, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

27153 Issued in WV

Practice address

107 Koontz Ave
Clendenin, WV 25045-9578

Phone

(304) 548-7272

Fax

(304) 548-7149

NPI assigned

Dec 27, 2011

Last updated

May 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

West Virginia University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cabin Creek Health Center IncGroup PAC ID 2466431101, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: donald.ta.1@7267.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/7267/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cabin Creek Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Dawes, WV
  • NPI 1366495525
  Medicare reassignment Care Compare group NPD
• Cabin Creek Health Center, Inc.

  dba Westside Health Center

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1194596759
  NPD
• Cabin Creek Health Center, Inc.

  dba Clendenin Health Center

  • Federally Qualified Health Center (FQHC)
  • Clendenin, WV
  • NPI 1437199742
  NPD
• Clendenin Health Center Pharmacy at Riverview

  dba Riverview Pharmacy

  • Community/Retail Pharmacy
  • Clendenin, WV
  • NPI 1285928804
  NPD (past)

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

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1376812008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ALEX LN",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042952",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 KOONTZ AVE",
            "city": "CLENDENIN",
            "state": "WV",
            "postal_code": "250459578",
            "telephone_number": "304-548-7272",
            "fax_number": "304-548-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TA",
        "first_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-27",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "27153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Lee Smith
• Robert Smith
• Jennifer Marie Snell
• Amber Springston
• Destiny Sky Stephenson
• Judith Taylor
• Jennifer Lynn Thayer, PA-C
• Joshua Thomas
• Amy Thompson
• Chava Zemirah Urecki, PSY.D.

• Pediatrics Physician in Clendenin, WV
• Providers in Clendenin, WV by specialty
• Pediatrics Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.