Individual provider Active NPI

Stacy Leigh Skidmore, PA-C

  • Physician Assistant
  • Morgantown, WV
National Provider Identifier
1730300948
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
01048 Issued in WV
Practice address
1 Stadium Drive Physician Office Center
Morgantown, WV 26506-9196
Phone
(304) 293-3900
Fax
(304) 293-7042
NPI assigned
May 2, 2007
Last updated
Nov 2, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 01048 WV Primary

Addresses

Primary practice location

1 Stadium Drive Physician Office Center
Morgantown, WV 26506-9196

Mailing address

114 Park Place Dr
Morgantown, WV 26508-4521
Phone (724) 288-7632

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
I20040512000798 WV Practitioner - Physician Assistant 4688663776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Medical Ctr Dr
Morgantown, WV 26506-1200
Phone (304) 598-4865

6040 University Town Centre Dr
Morgantown, WV 26501-2421
Phone (855) 988-2273

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wvu Medical Corporation Physician Assistant CurrentSince Oct 22, 2003 Accepting new patients
West Virginia University Medical Corporation CurrentSince Oct 22, 2003 Accepting new patients

Locations

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1730300948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 PARK PLACE DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265084521",
            "telephone_number": "724-288-7632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 STADIUM DRIVE PHYSICIAN OFFICE CENTER",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265069196",
            "telephone_number": "304-293-3900",
            "fax_number": "304-293-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKIDMORE",
        "first_name": "STACY",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

Verify at the official NPI Registry.