NPIMap

Individual provider Active NPI

David Michael Life, MD

  • Family Medicine Physician
  • Hurricane, WV
National Provider Identifier
1467416875
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17526 Issued in WV
Practice address
147 Willow Tree Way
Hurricane, WV 25526-1085
Phone
(304) 397-3002
Fax
(304) 397-3007
NPI assigned
Apr 13, 2006
Last updated
Apr 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 17526 WV
Family Medicine Physician 207Q00000X 17526 WV Primary

Addresses

Primary practice location

147 Willow Tree Way
Hurricane, WV 25526-1085

Mailing address

PO Box 4190
Barboursville, WV 25504-4190
Phone (304) 399-4405

Other identifiers 2

IdentifierTypeStateIssuer
P00138935OtherRAILROAD MEDICARE
0054842-000MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address david.life@smmm.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040804000090 WV Practitioner - Family Practice 2769453703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2900 1St Ave
Suite 1
Huntington, WV 25702-1241
Phone (304) 526-1234

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Medical Management, LLC CurrentSince Jun 25, 2013 Accepting new patients
St. Mary's Medical Management, LLC Family Medicine CurrentSince Jun 25, 2013 Accepting new patients
Cross Lanes Family Practice, Inc. (Lab) Past Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients
Integrated Health Care Providers Past Accepting new patients
Emcare Physician Providers Inc. Emergency Medicine Past Accepting new patients

Locations

2900 1st Ave
Huntington, WV 25702
Phone (304) 526-1111

3075 US Route 60
Huntington, WV 25705
Phone (304) 733-0004

147 Willow Tree Way
Hurricane, WV 25526
Phone (304) 397-3002

Interoperability endpoints

  • Direct secure messaging: david.life@smmm.cernerdirect.com

Organizations & group practices 6

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1467416875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4190",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255044190",
            "telephone_number": "304-399-4405",
            "fax_number": "304-399-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 WILLOW TREE WAY",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255261085",
            "telephone_number": "304-397-3002",
            "fax_number": "304-397-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIFE",
        "first_name": "DAVID",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "17526",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "17526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00138935",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0054842-000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david.life@smmm.cernerdirect.com",
            "affiliation": "N",
            "address_1": "147 Willow Tree Way",
            "city": "Hurricane",
            "state": "WV",
            "country_code": "US",
            "postal_code": "255261085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hurricane, WV

Sources for this page

Verify at the official NPI Registry.