NPIMap

Individual provider Active NPI

Mark R Waddell, DO

  • Family Medicine Physician
  • Lewisburg, WV
National Provider Identifier
1780741066
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1317 Issued in WV
Practice address
1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone
(304) 645-3220
Fax
(844) 479-4545
NPI assigned
Jan 3, 2007
Last updated
Sep 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 1317 WV
Family Medicine Physician 207Q00000X 1317 WV Primary

Addresses

Primary practice location

1464 Jefferson St N
Lewisburg, WV 24901-1380

Mailing address

1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone (304) 645-3220

Other practice location 1

100 Hoylman Dr
Gassaway, WV 26624-9321
Phone (304) 364-1060

Other practice location 2

1320 Maplewood Ave
Ronceverte, WV 24970-8016
Phone (304) 645-3220

Other identifiers 1

IdentifierTypeStateIssuer
0044268001MedicaidWV

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mwaddell7467@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address mwaddell7467@direct.wvuhsdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040330000679 WV Practitioner - Family PracticePractitioner - Osteopathic Manipulative MedicinePractitioner - Emergency Medicine 7719979038 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 1990
Medicare assignment
May accept Medicare assignment
Group practices
West Virginia School of Osteopathic Medicine Clinic IncGroup PAC ID 0941113427, shared by 2 NPIs, 33 clinicians

Practice addresses (Care Compare)

1320 Maplewood Ave
Ronceverte, WV 24970-8016
Phone (304) 647-4411

1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone (304) 645-3220

356 Nicholas St
Rupert, WV 25984-7708
Phone (304) 645-3220

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

Organizations & group practices 6

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 6

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1780741066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hoylman Dr",
            "address_purpose": "LOCATION",
            "city": "Gassaway",
            "state": "WV",
            "postal_code": "266249321",
            "country_code": "US",
            "telephone_number": "304-364-1060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 Maplewood Ave",
            "address_purpose": "LOCATION",
            "city": "Ronceverte",
            "state": "WV",
            "postal_code": "249708016",
            "country_code": "US",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "1317",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "1317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044268001",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwaddell7467@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Hoylman Dr",
            "city": "Gassaway",
            "state": "WV",
            "country_code": "US",
            "postal_code": "266249318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwaddell7467@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Hoylman Dr",
            "city": "Gassaway",
            "state": "WV",
            "country_code": "US",
            "postal_code": "266249318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lewisburg, WV

Sources for this page

Verify at the official NPI Registry.