Individual provider Active NPI

David Alan Haynes Jr., DPT

  • Physical Therapist
  • Cross Lanes, WV
National Provider Identifier
1902221310
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT2942 Issued in WV
Practice address
314 Goff Mountain Rd. (Ste 13)
Ste 13
Cross Lanes, WV 25313
Phone
(304) 776-5031
Fax
(304) 204-6332
NPI assigned
Feb 20, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT2942 WV Primary

Addresses

Primary practice location

314 Goff Mountain Rd. (Ste 13)
Ste 13
Cross Lanes, WV 25313

Mailing address

314 Goff Mountain Rd. (Ste 13)
Ste 13
Cross Lanes, WV 25313
Phone (304) 776-5031

Other identifiers 1

IdentifierTypeStateIssuer
3810027186MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140429001751 WV Practitioner - Physical Therapist in Private Practice 0042443905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medcare Therapy CenterGroup PAC ID 3375536675, 4 clinicians

Practice addresses (Care Compare)

314 Goff Mountain Rd
Suite 13
Cross Lanes, WV 25313-6600
Phone (304) 776-5031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT2942WVMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Medcare Therapy Center Physical Therapist CurrentSince Jul 8, 2019 Accepting new patients
Generations R.C., Inc Physical Therapist Past Accepting new patients

Locations

314 Goff Mountain Rd
Ste 13
Cross Lanes, WV 25313
Phone (304) 776-5031

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1902221310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 GOFF MOUNTAIN RD. (STE 13)",
            "address_2": "STE 13",
            "city": "CROSS LANES",
            "state": "WV",
            "postal_code": "25313",
            "telephone_number": "304-776-5031",
            "fax_number": "304-204-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 GOFF MOUNTAIN RD. (STE 13)",
            "address_2": "STE 13",
            "city": "CROSS LANES",
            "state": "WV",
            "postal_code": "25313",
            "telephone_number": "304-776-5031",
            "fax_number": "304-204-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "DAVID",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-20",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "PT2942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810027186",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cross Lanes, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.

Verify at the official NPI Registry.