Individual provider Active NPI

Amanda Ketterman, CNM

  • Advanced Practice Midwife
  • Buckhannon, WV
National Provider Identifier
1417352766
Registry record updated Oct 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
APRN62935 Issued in WV
Practice address
1 Amalia Dr
Buckhannon, WV 26201-2239
Phone
(304) 472-7473
NPI assigned
Oct 29, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X APRN62935 WV Primary

Addresses

Primary practice location

1 Amalia Dr
Buckhannon, WV 26201-2239

Mailing address

1 Amalia Dr
Buckhannon, WV 26201-2239

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150217001710 WV Practitioner - Certified Nurse Midwife (CNM) 0042535908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
APRN62935WVMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Apr 17, 2017 Accepting new patients
West Virginia University Medical Corporation CurrentSince Apr 17, 2017 Accepting new patients

Locations

1 Amalia Dr
Buckhannon, WV 26201
Phone (304) 473-2000

4 Northridge Dr
Ste 118
Buckhannon, WV 26201
Phone (304) 473-1440

100 W Main St
Buckhannon, WV 26201
Phone (304) 472-7473

4498 Potomac Highlands Trl
Green Bank, WV 24944
Phone (304) 456-5115

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

78 Queens Alley Rd
Rock Cave, WV 26234

266 Skidmore Ln
Sutton, WV 26601
Phone (304) 765-0351

149 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022

Interoperability endpoints

  • Direct secure messaging: aketterman102700@direct.wvuhsdirect.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414540800000",
    "number": "1417352766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 AMALIA DR",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262012239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AMALIA DR",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262012239",
            "telephone_number": "304-472-7473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERMAN",
        "first_name": "AMANDA",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2014-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WV",
            "license": "APRN62935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckhannon, WV

Sources for this page

Verify at the official NPI Registry.