NPIMap

Individual provider Active NPI

Richard W Craddock, PA-C

  • Physician Assistant
  • South Charleston, WV
National Provider Identifier
1467768804
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
00292 Issued in WV
Practice address
500 Poplar St
South Charleston, WV 25309-1474
Phone
(304) 342-3891
Fax
(304) 342-5307
NPI assigned
Aug 24, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 00292 WV Primary

Addresses

Primary practice location

500 Poplar St
South Charleston, WV 25309-1474

Mailing address

500 Poplar St
South Charleston, WV 25309-1474
Phone (304) 342-3891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
00292WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Capitol Neurology PLLC Past Accepting new patients
Herbert J Thomas Memorial Hospital Association Past Accepting new patients
University Physicians & Surgeons, Inc Physician Assistant Past Accepting new patients

Organizations & group practices 3

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": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1467768804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 POPLAR ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091474",
            "telephone_number": "304-342-3891",
            "fax_number": "304-342-5307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 POPLAR ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091474",
            "telephone_number": "304-342-3891",
            "fax_number": "304-342-5307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADDOCK",
        "first_name": "RICHARD",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-24",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "00292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.