NPIMap

Individual provider Active NPI

Shane Wriston, PA-C

  • Medical Physician Assistant
  • Ivydale, WV
National Provider Identifier
1609277201
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
01845 Issued in WV
Practice address
797 Clinic Dr
Ivydale, WV 25113-8263
Phone
(304) 286-4200
Fax
(304) 286-2107
NPI assigned
Sep 15, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 01845 WV Primary

Addresses

Primary practice location

797 Clinic Dr
Ivydale, WV 25113-8263

Mailing address

797 Clinic Dr
Ivydale, WV 25113-8263
Phone (304) 286-4200

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
I20141217001860 WV Practitioner - Physician Assistant 8426371733 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care of West Virginia, Inc.Group PAC ID 0446232987, 89 clinicians

Practice addresses (Care Compare)

122 Ctr St
Clay, WV 25043-7046
Phone (304) 587-7301

797 Clinic Dr
Ivydale, WV 25113-8263
Phone (304) 286-4200

Hospital & facility affiliations

  • St Joseph'S Hospital of Buckhannon, Inc Hospital, Buckhannon, WV, CCN 511321
  • Braxton County Memorial Hospital, Inc Hospital, Gassaway, WV, CCN 511308
  • Roane General Hospital Hospital, Spencer, WV, CCN 511306
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care of West Virginia Inc CurrentSince Feb 1, 2018 Accepting new patients
WV Asthma and Allergy Centers, Inc. CurrentSince Sep 20, 2014 Accepting new patients
Community Care of West Virginia, Inc. CurrentSince Feb 1, 2018 Accepting new patients
WV Asthma and Allergy Centers, Inc. CurrentSince Sep 20, 2014 Accepting new patients
Community Care of West Virginia, Inc. Past Accepting new patients

Locations

208 Maccorkle Ave SE
Charleston, WV 25314
Phone (304) 343-4300

797 Clinic Dr
Ivydale, WV 25113
Phone (304) 286-4200

249 Skidmore Ln
Sutton, WV 26601
Phone (304) 317-7275

Interoperability endpoints

  • Direct secure messaging: shane.wriston.1@4803.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1410739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1609277201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "797 CLINIC DR",
            "city": "IVYDALE",
            "state": "WV",
            "postal_code": "251138263",
            "telephone_number": "304-286-4200",
            "fax_number": "304-286-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "797 CLINIC DR",
            "city": "IVYDALE",
            "state": "WV",
            "postal_code": "251138263",
            "telephone_number": "304-286-4200",
            "fax_number": "304-286-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRISTON",
        "first_name": "SHANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-15",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ivydale, WV

Sources for this page

Verify at the official NPI Registry.