Active NPI
Charles Henry Staab III, MD
- Family Medicine Physician
- Wheeling, WV
National Provider Identifier
1598766016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11194
- Practice address
- 30 Medical Park
Suite 223
Wheeling, WV 26003-6391 - Phone
- (304) 242-3300
- Fax
- (304) 242-8964
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11194 | WV | Primary |
Addresses
Primary practice location
30 Medical Park
Suite 223
Wheeling, WV 26003-6391
Mailing address
30 Medical Park
Suite 223
Wheeling, WV 26003-6391
Phone (304) 242-3300
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0111925000 | Medicaid | WV | |
| 0361111 | Medicaid | OH | |
| 216250 | Other | UPMC | |
| 11194C | Other | HEALTH PLAN OF UPPER OH V | |
| 875707 | Other | MAMSI |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11194 | WV | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598766016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 MEDICAL PARK",
"address_2": "SUITE 223",
"city": "WHEELING",
"state": "WV",
"postal_code": "260036391",
"telephone_number": "304-242-3300",
"fax_number": "304-242-8964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 MEDICAL PARK",
"address_2": "SUITE 223",
"city": "WHEELING",
"state": "WV",
"postal_code": "260036391",
"telephone_number": "304-242-3300",
"fax_number": "304-242-8964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAAB",
"first_name": "CHARLES",
"middle_name": "HENRY",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "11194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0111925000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0361111",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPMC",
"identifier": "216250",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN OF UPPER OH V",
"identifier": "11194C",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "875707",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheeling, WV
- Donna Lee Spratt, MD
- St. John'S/St. Vincent'S Home for Children, Inc
- St. John'S/St. Vincents'S Home for Children, Inc.
- St. John'S/St.Vincent'S Home for Children, Inc.
- Carla Jo St. Myers, FNP-BC
- Terry L Stake, M.D.
- Stacie Morgan Starkey
- Valery Lynne Staskey, TSW
- Tonda Marie Stauffer, PA-C
- Joshua Steed
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.