NPIMap

Organization Active NPI

Lifetree Medical Services, LLC

  • Nurse Practitioner
  • Danville, WV
National Provider Identifier
1487178331
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LIFETREE MEDICAL SERVICES, LLC
Practice address
462 Kenmore Dr
Danville, WV 25053-7133
Phone
(304) 369-0986
NPI assigned
Aug 2, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Authorized official

Name
Mr. Todd R Jones
Title
President
Phone
(304) 344-1623

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

462 Kenmore Dr
Danville, WV 25053-7133

Mailing address

PO Box 280
Cabin Creek, WV 25035-0280
Phone (304) 556-1060

Other practice location 1

6999 Route 152
Wayne, WV 25570-8285
Phone (304) 697-7007

Other practice location 2

411 Erbacon Rd
Cowen, WV 26206-8526
Phone (304) 226-5301

Other practice location 3

236 Warrior Way
New Richmond, WV 24867
Phone (304) 294-7586

Other practice location 4

640 Sandhill Rd
Point Pleasant, WV 25550-2163
Phone (304) 675-5236

Other practice location 5

2096 Davisson Run Rd
Clarksburg, WV 26301-7361
Phone (304) 624-6500

Other practice location 6

2 Hospital Plz
Grafton, WV 26354-1283
Phone (304) 265-0008

Other practice location 7

30 Hidden Brook Way
Culloden, WV 25510-9190
Phone (304) 390-5709

Other practice location 8

859 Days Dr
Sutton, WV 26601-6255
Phone (304) 765-2861

Other practice location 9

1053 Clinic Dr
Ivydale, WV 25113-8266
Phone (304) 286-4204

Other practice location 10

100 Hresan Blvd
Fayetteville, WV 25840-1333
Phone (304) 574-0770

Other practice location 11

1115 Maplewood Ave
Lewisburg, WV 24901-9728
Phone (304) 645-3076

Other practice location 12

18086 State Route 55
Baker, WV 26801
Phone (304) 897-5903

Other practice location 13

1081 Maplewood Dr
Bridgeport, WV 26330-9848
Phone (304) 842-4135

Other practice location 14

200 Monday Dr
Hamlin, WV 25523-1033
Phone (304) 824-3133

Other practice location 15

20 Wilson Drive
Cameron, WV 26033
Phone (304) 636-3318

Other practice location 16

150 Venus Dr
Gary, WV 24836
Phone (304) 448-2121

Other practice location 17

1275 Southview Dr
Bluefield, WV 24701-4347
Phone (304) 325-5448

Other practice location 18

198 John Cook Nursing Home Rd
Hinton, WV 25951-5074
Phone (304) 466-0332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171103002876 WV Part B Supplier - Clinic/Group Practice 8426314667 Receives reassigned benefits from 5 practitioners
Practice locations: Gary, WV; Grafton, WV; Hamlin, WV; Hinton, WV; Ivydale, WV; Lewisburg, WV; New Richmond, WV; Point Pleasant, WV…

National Provider Directory

National Provider Directory

Locations

1081 Maplewood Dr
Bridgeport, WV 26330
Phone (304) 842-4135

462 Kenmore Dr
Danville, WV 25053
Phone (304) 369-0986

1115 Maplewood Ave
Lewisburg, WV 24901
Phone (304) 645-3076

6999 Route 152
#1372
Wayne, WV 25570
Phone (304) 697-7007

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1487178331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "CABIN CREEK",
            "state": "WV",
            "postal_code": "250350280",
            "telephone_number": "304-556-1060",
            "fax_number": "304-556-1061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 KENMORE DR",
            "city": "DANVILLE",
            "state": "WV",
            "postal_code": "250537133",
            "telephone_number": "304-369-0986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6999 Route 152",
            "address_purpose": "LOCATION",
            "city": "Wayne",
            "state": "WV",
            "postal_code": "255708285",
            "country_code": "US",
            "telephone_number": "304-697-7007",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "411 Erbacon Rd",
            "address_purpose": "LOCATION",
            "city": "Cowen",
            "state": "WV",
            "postal_code": "262068526",
            "country_code": "US",
            "telephone_number": "304-226-5301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "236 Warrior Way",
            "address_purpose": "LOCATION",
            "city": "New Richmond",
            "state": "WV",
            "postal_code": "24867",
            "country_code": "US",
            "telephone_number": "304-294-7586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Sandhill Rd",
            "address_purpose": "LOCATION",
            "city": "Point Pleasant",
            "state": "WV",
            "postal_code": "255502163",
            "country_code": "US",
            "telephone_number": "304-675-5236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2096 Davisson Run Rd",
            "address_purpose": "LOCATION",
            "city": "Clarksburg",
            "state": "WV",
            "postal_code": "263017361",
            "country_code": "US",
            "telephone_number": "304-624-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Hospital Plz",
            "address_purpose": "LOCATION",
            "city": "Grafton",
            "state": "WV",
            "postal_code": "263541283",
            "country_code": "US",
            "telephone_number": "304-265-0008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 Hidden Brook Way",
            "address_purpose": "LOCATION",
            "city": "Culloden",
            "state": "WV",
            "postal_code": "255109190",
            "country_code": "US",
            "telephone_number": "304-390-5709",
            "fax_number": "304-743-1994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "859 Days Dr",
            "address_purpose": "LOCATION",
            "city": "Sutton",
            "state": "WV",
            "postal_code": "266016255",
            "country_code": "US",
            "telephone_number": "304-765-2861",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1053 Clinic Dr",
            "address_purpose": "LOCATION",
            "city": "Ivydale",
            "state": "WV",
            "postal_code": "251138266",
            "country_code": "US",
            "telephone_number": "304-286-4204",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Hresan Blvd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "WV",
            "postal_code": "258401333",
            "country_code": "US",
            "telephone_number": "304-574-0770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1115 Maplewood Ave",
            "address_purpose": "LOCATION",
            "city": "Lewisburg",
            "state": "WV",
            "postal_code": "249019728",
            "country_code": "US",
            "telephone_number": "304-645-3076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18086 State Route 55",
            "address_purpose": "LOCATION",
            "city": "Baker",
            "state": "WV",
            "postal_code": "26801",
            "country_code": "US",
            "telephone_number": "304-897-5903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1081 Maplewood Dr",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "WV",
            "postal_code": "263309848",
            "country_code": "US",
            "telephone_number": "304-842-4135",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Monday Dr",
            "address_purpose": "LOCATION",
            "city": "Hamlin",
            "state": "WV",
            "postal_code": "255231033",
            "country_code": "US",
            "telephone_number": "304-824-3133",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Wilson Drive",
            "address_purpose": "LOCATION",
            "city": "Cameron",
            "state": "WV",
            "postal_code": "26033",
            "country_code": "US",
            "telephone_number": "304-636-3318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 Venus Dr",
            "address_purpose": "LOCATION",
            "city": "Gary",
            "state": "WV",
            "postal_code": "24836",
            "country_code": "US",
            "telephone_number": "304-448-2121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1275 Southview Dr",
            "address_purpose": "LOCATION",
            "city": "Bluefield",
            "state": "WV",
            "postal_code": "247014347",
            "country_code": "US",
            "telephone_number": "304-325-5448",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "198 John Cook Nursing Home Rd",
            "address_purpose": "LOCATION",
            "city": "Hinton",
            "state": "WV",
            "postal_code": "259515074",
            "country_code": "US",
            "telephone_number": "304-466-0332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFETREE MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-344-1623",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.