Michael Vaughn Baxter Bledsoe, D.O.
Individual provider Active NPI Family Medicine Physician · Ronceverte, WV
NPI 1770979874 · NPPES record last updated Nov 1, 2023
Key facts
- NPI
- 1770979874
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3097 (WV)
- Practice address
- 1320 Maplewood Ave
Ronceverte, WV 24970-8016 - Phone
- (304) 647-4411
- NPI assigned
- Apr 15, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- West Virginia School of Osteopathic Medicine, 2015
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Camc Greenbrier Valley Medical Center Inc
Oak Hill Emergency Physicians, LLC
Practice addresses (Care Compare)
1320 Maplewood Ave
Ronceverte, WV 24970-8016
Phone (304) 647-4411
430 Main St W
Oak Hill, WV 25901-3414
Phone (304) 647-4411
Hospital & facility affiliations
- Camc Greenbrier Valley Medical Center, Inc
- Camc Plateau Medical Center, Inc
- Boone Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.94 of 100
- Quality
- 69.71
- Promoting interoperability
- 100
- Improvement activities
- 40
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 |
|---|---|---|---|---|
| I20180905001337 | WV | Practitioner - Family Practice | 7810203163 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3097 | WV | MD | Professional Counselor |
| 309 | WV | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charleston Area Medical Center, Inc. | Current |
Accepting new patients | |
| Boone Memorial Hospital, Inc | Current | Accepting new patients | |
| Boone Memorial Hospital, Inc | Family Medicine | Current | Accepting new patients |
| Charleston Area Medical Center, Inc. | Current | Accepting new patients | |
| Camc Greenbrier Valley Medical Center Inc | Family Medicine | Current |
Accepting new patients |
| Boone Memorial Hospital, Inc | Family Medicine | Current |
Accepting new patients |
| Charleston Area Medical Center Inc | Current |
Accepting new patients | |
| Oak Hill Emergency Physicians, LLC | Current |
Accepting new patients | |
| Camc Greenbrier Valley Medical Center, Inc. | Current |
Accepting new patients | |
| Boone Memorial Hospital, Inc | Current |
Accepting new patients | |
| Boone Memorial Hospital, Inc | Past | Accepting new patients | |
| Boone Memorial Hospital, Inc | Past | Accepting new patients | |
| Boone Memorial Hospital, Inc | Past | Accepting new patients |
Locations
400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762
6952 Coal River Rd
#C
Comfort, WV 25049
Phone (304) 307-3116
300 4th St
Danville, WV 25053
Phone (304) 307-6201
716 Madison Ave
Madison, WV 25130
Phone (304) 369-1230
660 S Main St
#A
Madison, WV 25130
Phone (304) 369-1230
701 Madison Ave
Madison, WV 25130
Phone (304) 369-1230
430 Main St W
Oak Hill, WV 25901
Phone (276) 325-0678
1521 Maplewood Ave
Ronceverte, WV 24970
1320 Maplewood Ave
Ronceverte, WV 24970
Phone (304) 645-0870
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/boonemh-81155461
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3097 | WV | Yes |
Addresses
Primary practice location
1320 Maplewood Ave
Ronceverte, WV 24970-8016
Mailing address
1320 Maplewood Ave
Ronceverte, WV 24970-8016
Phone (304) 647-4411
Other practice location 1
701 Madison Ave
Madison, WV 25130-1669
Phone (304) 369-1230
Other providers in Ronceverte, WV
- Xuan Le Berry
- Michael Bilger
- Andrea Bird
- BJSM Med Inc
- Tonia Michelle Blankenship
- Blink, Inc.
- Blink, Inc.
- Brittany Bonner
- Thomas C Booth II
- Jessica E Bower
All providers in Ronceverte, WV · Family 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 Nov 1, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.