NPIMap

Individual provider Active NPI

Isidro A Amigo, D.O.

  • Surgery Physician
  • Grafton, WV
National Provider Identifier
1821049339
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1181 Issued in WV
Practice address
8 Rose St
Grafton, WV 26354-1678
Phone
(304) 265-0095
Fax
(304) 265-6215
NPI assigned
May 12, 2006
Last updated
Apr 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 34002976 OH
Surgery Physician 208600000X 1181 WV Primary

Addresses

Primary practice location

8 Rose St
Grafton, WV 26354-1678

Mailing address

PO Box 42738
Towson, MD 21284-2738
Phone (844) 468-9502

Other identifiers 2

IdentifierTypeStateIssuer
0551675MedicaidOH
0128645000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1354ALMDProfessional Counselor
2976OHMDChiropractor
1181WVMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Vaughan Physician Practices LLC Past Accepting new patients
Vaughan Physician Practices LLC Surgery Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459987200000",
    "number": "1821049339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42738",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212842738",
            "telephone_number": "844-468-9502",
            "fax_number": "317-663-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 ROSE ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541678",
            "telephone_number": "304-265-0095",
            "fax_number": "304-265-6215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMIGO",
        "first_name": "ISIDRO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2016-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "34002976",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WV",
            "license": "1181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0551675",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0128645000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grafton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.