Alice Jody Ackerman, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2159 Issued in WV

Practice address

1 Healthcare Dr
Mansfield Hill
Philippi, WV 26416

Phone

(304) 457-1760

Fax

(304) 457-3781

NPI assigned

Feb 2, 2006

Last updated

Apr 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Emergency Medicine

Education

Philadelphia College of Osteopathic Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Broaddus Hospital Association Inc.Group PAC ID 5991692832, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vandalia Health Broaddus Hospital Hospital, Philippi, WV, CCN 511300

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Broaddus Hospital Association, Inc.

  • Critical Access Hospital
  • Philippi, WV
  • NPI 1548246622
  Medicare reassignment Care Compare group NPD
• Ultrasound Services, Inc

  • Physiological Laboratory
  • Newtown, PA
  • NPI 1740224062
  NPD (past)

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

• Broaddus Hospital Association, Inc.

  • Critical Access Hospital
  • Philippi, WV
  • NPI 1548246622
  Care Compare affiliation

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1730151010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HEALTHCARE DR",
            "address_2": "MANSFIELD HILL",
            "city": "PHILIPPI",
            "state": "WV",
            "postal_code": "264169405",
            "telephone_number": "304-457-1760",
            "fax_number": "304-457-3781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HEALTHCARE DR",
            "address_2": "MANSFIELD HILL",
            "city": "PHILIPPI",
            "state": "WV",
            "postal_code": "26416",
            "telephone_number": "304-457-1760",
            "fax_number": "304-457-3781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKERMAN",
        "first_name": "ALICE",
        "middle_name": "JODY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-02",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "2159",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "2159",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "05-009868-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001782911 (00008)",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004790",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00375987",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE HEALTH PLAN",
            "identifier": "WV02159A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOUNTAIN STATE BCS",
            "identifier": "001817913",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Siobhan Ahern, CF-SLP
• Sierra Alston
• Raymond Alth
• Dawn Andrews
• Derek Michael Andrews, DPT

• Emergency Medicine Physician in Philippi, WV
• Providers in Philippi, WV by specialty
• Emergency Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.