Gerod Buckhalter, PRSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

21-9129 Issued in WV

Practice address

206 Spruce St
Morgantown, WV 26505-7539

Phone

(304) 413-4300

NPI assigned

Aug 10, 2022

Last updated

Aug 10, 2022By 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Morgantown Sober Living, Inc.

  • Substance Abuse Rehabilitation Facility
  • Morgantown, WV
  • NPI 1861152076
  NPD

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1427786128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 SPRUCE ST",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265057539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 SPRUCE ST",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265057539",
            "telephone_number": "304-413-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKHALTER",
        "first_name": "GEROD",
        "credential": "PRSS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WV",
            "license": "21-9129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21-9129",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "na",
            "affiliation": "N",
            "endpointDescription": "na",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "206 Spruce St",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265057539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lance Bryson, PA-C
• Terri Lynn Bubnar, LPC-P
• Brooke Buchanan
• Elian Buchi, MS
• Olesya Alexandra Buck
• Hannah Buckingham
• Patty Bucklew
• Amanda I Buckley, LGSW
• Richard Buckner
• Cathrin Buetefisch, M.D.

• Peer Specialist in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Peer Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.