Thomas Bailey, MD
Individual provider Active NPI Addiction Medicine (Internal Medicine) Physician · Beaver, WV
NPI 1659359396 · NPPES record last updated Oct 31, 2023
Key facts
- NPI
- 1659359396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction Medicine (Internal Medicine) Physician 207RA0401X
- License
- 17538 (WV)
- Practice address
- 175 Philpott LN
Beaver, WV 25813-9501 - Phone
- (304) 254-9262
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060310000419 | WV | Practitioner - Emergency Medicine | 1052328333 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17538 | WV | MD | Addiction Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beckley Treatment Center, LLC | Current |
Accepting new patients | |
| Beckley Treatment Center, LLC | Current |
Accepting new patients | |
| Beckley Treatment Center, LLC | Current |
Accepting new patients | |
| Charleston Area Medical Center Inc | Past | Accepting new patients |
Locations
6100 Tower Cir
Ste 1000
Franklin, TN 37067
Phone (615) 454-7459
175 Philpott Ln
Beaver, WV 25813
Phone (304) 254-9262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Internal Medicine) Physician | 207RA0401X | 17538 | WV | Yes |
Addresses
Primary practice location
175 Philpott LN
Beaver, WV 25813-9501
Mailing address
175 Philpott LN
Beaver, WV 25813-9501
Phone (304) 254-9262
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001718055 | Other | WV | WV BCBS |
| 1053229 | Other | WV | WV DWC |
| 17538 | Other | WV | LICENSE |
| 1801525000 | Medicaid | WV |
Other providers in Beaver, WV
- Alisha Danyiel Anderson
- Austin Luke Angel
- James W Aurentz
- Back to Health Chiropractic
- Jill Keneda Bailey
- Leisha Banks
- James E Beaver Jr.
- Beckley Treatment Center, LLC
- Beckley Treatment Center, LLC
- Beckley Treatment Center, LLC
All providers in Beaver, WV · Addiction Medicine (Internal Medicine) Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.