Individual provider Active NPI

Tina L Waugh, APRN

  • Primary Care Nurse Practitioner
  • Paw Paw, WV
National Provider Identifier
1639693468
Registry record updated Aug 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APRN94035-NP-C Issued in WV
Practice address
783 Winchester St
Paw Paw, WV 25434
Phone
(304) 947-5500
Fax
(304) 947-5563
NPI assigned
Aug 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X APRN94035-NP-C WV Primary

Addresses

Primary practice location

783 Winchester St
Paw Paw, WV 25434

Mailing address

PO Box 2
Paw Paw, WV 25434-0002
Phone (304) 947-5500

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
I20171208000420 WV Practitioner - Nurse Practitioner 3375800824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

783 Winchester St
Paw Paw, WV 25434-3258

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN94035-NP-CWVMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mountaineer Community Health Center, Inc. CurrentSince Jul 22, 2017 Accepting new patients

Locations

783 Winchester St
Paw Paw, WV 25434
Phone (304) 947-5500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11497/brand/1/csg/1/fhir/r4
  • Direct secure messaging: tina.waugh.1@11497.direct.athenahealth.com

Organizations & group practices 1

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501632000000",
    "number": "1639693468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2",
            "city": "PAW PAW",
            "state": "WV",
            "postal_code": "254340002",
            "telephone_number": "304-947-5500",
            "fax_number": "304-947-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "783 WINCHESTER ST",
            "city": "PAW PAW",
            "state": "WV",
            "postal_code": "25434",
            "telephone_number": "304-947-5500",
            "fax_number": "304-947-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAUGH",
        "first_name": "TINA",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2017-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WV",
            "license": "APRN94035-NP-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, WV

Sources for this page

Verify at the official NPI Registry.