Active NPI
Sue Ann Upton, M.D.
- Pediatrics Physician
- Charleston, WV
National Provider Identifier
1922061076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 18217
- Practice address
- 830 Pennsylvania Ave
Suite 200
Charleston, WV 25302-3302 - Phone
- (304) 343-1863
- Fax
- (304) 344-1755
- NPI assigned
- Apr 10, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 18217 | WV | Primary |
Addresses
Primary practice location
830 Pennsylvania Ave
Suite 200
Charleston, WV 25302-3302
Mailing address
19 Woodberry LN
Charleston, WV 25304-2732
Phone (304) 343-1863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003000000 | Medicaid | WV |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18217 | WV | MD | Pediatrics Physician |
Interoperability endpoints
- sue.upton@abcpeds.directbygreenway.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310083200000",
"number": "1922061076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 WOODBERRY LN",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042732",
"telephone_number": "304-343-1863",
"fax_number": "304-344-1755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 PENNSYLVANIA AVE",
"address_2": "SUITE 200",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253023302",
"telephone_number": "304-343-1863",
"fax_number": "304-344-1755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UPTON",
"first_name": "SUE",
"middle_name": "ANN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-10",
"last_updated": "2011-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WV",
"license": "18217",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1003000000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.