Active NPI
Gary D Harris, PH.D.
- Audiologist
- South Charleston, WV
National Provider Identifier
1841373529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- A-0053
- Practice address
- 4501 Maccorkle Ave SW
Suite 402
South Charleston, WV 25309-1444 - Phone
- (304) 766-6555
- Fax
- (304) 768-2335
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | A-0053 | WV | Primary |
Addresses
Primary practice location
4501 Maccorkle Ave SW
Suite 402
South Charleston, WV 25309-1444
Mailing address
4501 Maccorkle Ave SW
Suite 402
South Charleston, WV 25309-1444
Phone (304) 766-6555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9460024 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120320000291 | WV | Practitioner - Qualified Audiologist | 0345341566 |
Care Compare profile
Medicare Care Compare- Specialty
- Qualified Audiologist
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
420 Greenway Ave
South Charleston, WV 25309-1426
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-0053 | WV | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243900800000",
"number": "1841373529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4501 MACCORKLE AVE SW",
"address_2": "SUITE 402",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253091444",
"telephone_number": "304-766-6555",
"fax_number": "304-768-2335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4501 MACCORKLE AVE SW",
"address_2": "SUITE 402",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253091444",
"telephone_number": "304-766-6555",
"fax_number": "304-768-2335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "GARY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2009-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "WV",
"license": "A-0053",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9460024",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.