Individual provider Active NPI

Kevin Sansom, PA-C

  • Physician Assistant
  • Huntington, WV
National Provider Identifier
1780385112
Registry record updated Apr 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2996 Issued in WV
Practice address
1340 Hal Greer Blvd
Huntington, WV 25701-3804
Phone
(304) 399-6727
Fax
(304) 399-6726
NPI assigned
Mar 13, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2023

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 2996 WV Primary

Addresses

Primary practice location

1340 Hal Greer Blvd
Huntington, WV 25701-3804

Mailing address

1303 Peter Cave Rd
Genoa, WV 25517-7732
Phone (304) 633-1940

Other identifiers 3

IdentifierTypeStateIssuer
0013276MedicaidOH
1780385112MedicaidWV
7100886040MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Kevin.Sansom@direct.chhi.org

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
I20230413000142 WV Practitioner - Physician Assistant 3476928052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cabell Huntington Hospital IncGroup PAC ID 3274436340, 88 clinicians

Practice addresses (Care Compare)

1340 Hal Greer Blvd
Huntington, WV 25701-3800
Phone (304) 691-8500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2996WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cabell Huntington Hospital Inc Physician Assistant CurrentSince Apr 10, 2023 Accepting new patients
Cabell Huntington Hospital Inc CurrentSince Apr 10, 2023 Accepting new patients

Locations

1340 Hal Greer Blvd
Huntington, WV 25701
Phone (304) 399-2960

Interoperability endpoints

  • Direct secure messaging: kevin.sansom@direct.chhi.org

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 and National Provider Directory roles.

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": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1780385112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 PETER CAVE RD",
            "city": "GENOA",
            "state": "WV",
            "postal_code": "255177732",
            "telephone_number": "304-633-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 HAL GREER BLVD",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013804",
            "telephone_number": "304-399-6727",
            "fax_number": "304-399-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANSOM",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0013276",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780385112",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100886040",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kevin.Sansom@direct.chhi.org",
            "affiliation": "N",
            "endpointDescription": "Cabell Huntington Hospital",
            "address_1": "1340 Hal Greer Blvd",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257013804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

Verify at the official NPI Registry.