Active NPI
Patsy J Fairchild, PA-C
- Physician Assistant
- Fayetteville, WV
National Provider Identifier
1649368119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 01218
- Practice address
- 221 W Maple Ave
Fayetteville, WV 25840-1413 - Phone
- (304) 574-3960
- Fax
- (304) 574-2179
- NPI assigned
- Oct 10, 2006
- Last updated
- Sep 7, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 01218 | WV | Primary |
| Physician Assistant | 363A00000X | 387 | WV |
Addresses
Primary practice location
221 W Maple Ave
Fayetteville, WV 25840-1413
Mailing address
PO Box 337
Scarbro, WV 25917-0337
Phone (304) 469-2905
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001969193 | Other | WV | MS BCBS |
| 3810007348 | Medicaid | WV | |
| 01218 | Other | WV | LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01218 | WV | MD | Physician Assistant |
| 387 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New River Health Association, Inc. | Past | Accepting new patients |
Interoperability endpoints
- patsy.fairchild@cog-wv.directbygreenway.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba New River Health Harper Road
- Federally Qualified Health Center (FQHC)
- Beckley, WV
- NPI 1033088331
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315353600000",
"number": "1649368119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 337",
"city": "SCARBRO",
"state": "WV",
"postal_code": "259170337",
"telephone_number": "304-469-2905",
"fax_number": "304-465-3180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 W MAPLE AVE",
"city": "FAYETTEVILLE",
"state": "WV",
"postal_code": "258401413",
"telephone_number": "304-574-3960",
"fax_number": "304-574-2179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRCHILD",
"first_name": "PATSY",
"middle_name": "J",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2011-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "01218",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "387",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS BCBS",
"identifier": "001969193",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810007348",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "01218",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.