Individual provider Active NPI

Arlene Vergara

  • Psychiatric/Mental Health Nurse Practitioner
  • Martinsburg, WV
National Provider Identifier
1528832276
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
118367 Issued in WV
Practice address
99 Tavern Rd
Martinsburg, WV 25401-2890
Phone
(304) 263-4999
NPI assigned
Nov 13, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X R199695 MD
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 118367 WV Primary

Addresses

Primary practice location

99 Tavern Rd
Martinsburg, WV 25401-2890

Mailing address

PO Box 60
Fairplay, MD 21733-0060
Phone (202) 670-7317

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240305001363 WV Practitioner - Nurse Practitioner 6507201126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

99 Tavern Rd
Martinsburg, WV 25401-2890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R199695MDMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Shenandoah Valley Medical System, Inc. CurrentSince Mar 18, 2024 Accepting new patients
Holistic Mind Psychiatry Inc. Psychiatric/Mental Health Current Accepting new patients
Shenandoah Valley Medical System, Inc. CurrentSince Mar 18, 2024 Accepting new patients
Shenandoah Valley Medical System, Inc. Past Accepting new patients
Shenandoah Valley Medical System, Inc. Past Accepting new patients

Locations

44 Trifecta Pl
Ste 205
Charles Town, WV 25414
Phone 30426349991063

99 Tavern Rd
Martinsburg, WV 25401
Phone (304) 263-7023

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: arlene.vergara.1@32629.direct.athenahealth.com

Organizations & group practices 5

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": "1699833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1528832276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60",
            "city": "FAIRPLAY",
            "state": "MD",
            "postal_code": "217330060",
            "telephone_number": "202-670-7317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 TAVERN RD",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254012890",
            "telephone_number": "304-263-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERGARA",
        "first_name": "ARLENE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-13",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R199695",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WV",
            "license": "118367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

Verify at the official NPI Registry.