Ada Tedder

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

License

15687960287 Issued in WV

Practice address

355 Bluefield Ave
Bluefield, WV 24701-2883

Phone

(304) 425-7111

Fax

(304) 425-1148

NPI assigned

Nov 8, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ada Tedder Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Community Action of Southeastern West Virginia

  • In Home Supportive Care Agency
  • Bluefield, WV
  • NPI 1568796027
  NPD (past)

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1821706987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BLUEFIELD AVE",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247012883",
            "telephone_number": "304-425-7111",
            "fax_number": "304-425-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BLUEFIELD AVE",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247012883",
            "telephone_number": "304-425-7111",
            "fax_number": "304-425-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDDER",
        "first_name": "ADA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "WV",
            "license": "15687960287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55-6025355",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ADA",
            "last_name": "TEDDER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Personal Care Attendant in Bluefield, WV
• Providers in Bluefield, WV by specialty
• Personal Care Attendant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.