NPIMap

Individual provider Active NPI

Rafael Modesto Rodighiero, PA-C

  • Medical Physician Assistant
  • Logan, WV
National Provider Identifier
1881969475
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
01624 Issued in WV
Practice address
122 Nick Savas Dr
Logan, WV 25601-3468
Phone
(304) 752-8081
Fax
(304) 752-8083
NPI assigned
Mar 14, 2012
Last updated
Feb 27, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 01624 WV Primary

Addresses

Primary practice location

122 Nick Savas Dr
Logan, WV 25601-3468

Mailing address

7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806

Other identifiers 1

IdentifierTypeStateIssuer
3810022963MedicaidWV

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
I20120330000365 WV Practitioner - Physician Assistant 1951561851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

462 Main St
Chapmanville, WV 25508-4574
Phone (304) 310-2517

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
01624WVMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln County Primary Care Center, Inc Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc Past Accepting new patients

Locations

7400 Lynn Ave
Hamlin, WV 25523

122 Nick Savas Dr
Logan, WV 25601
Phone (304) 752-8081

650 E McDonald Ave
Man, WV 25635
Phone (304) 583-8585

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 4

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": "1331683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1881969475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 NICK SAVAS DR",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013468",
            "telephone_number": "304-752-8081",
            "fax_number": "304-752-8083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODIGHIERO",
        "first_name": "RAFAEL",
        "middle_name": "MODESTO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-14",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810022963",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, WV

Sources for this page

Verify at the official NPI Registry.