NPIMap

Individual provider Active NPI

Myra D. Priddy, MD

  • Family Medicine Physician
  • Summersville, WV
National Provider Identifier
1952448532
Registry record updated Dec 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19575 Issued in WV
Practice address
315 Fairview Heights Rd
Summersville, WV 26651-1086
Phone
(304) 872-5213
Fax
(304) 872-5893
NPI assigned
Jan 31, 2007
Last updated
Dec 9, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 19575 WV
Family Medicine Physician 207Q00000X 19575 WV Primary

Addresses

Primary practice location

315 Fairview Heights Rd
Summersville, WV 26651-1086

Mailing address

127 Hidden Valley Ests
Scott Depot, WV 25560-9300
Phone (304) 253-9355

Other identifiers 1

IdentifierTypeStateIssuer
20150000MedicaidWV

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
I20050414001319 WV Practitioner - Emergency Medicine 3173560695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
JC Edwards School of Medicine, Marshall University, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Montgomery General Hospital, IncGroup PAC ID 6204735269, 37 clinicians

Practice addresses (Care Compare)

401 6TH Ave
Montgomery, WV 25136-2116
Phone (304) 442-5151

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19575WVMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montgomery General Hospital, Inc Family Medicine CurrentSince Mar 21, 2018 Accepting new patients
Montgomery General Hospital, Inc CurrentSince Mar 21, 2018 Accepting new patients
West Virginia University Medical Corporation Family Medicine Past Accepting new patients
Brian S. Love MD, Inc Family Medicine Past Accepting new patients
Patient Transportation Inc Past Accepting new patients
Emcare Physician Providers Inc. Emergency Medicine Past Accepting new patients

Locations

401 6th Ave
Montgomery, WV 25136
Phone (304) 442-5151

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6958/brand/1/csg/1/fhir/r4

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1952448532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 HIDDEN VALLEY ESTS",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609300",
            "telephone_number": "304-253-9355",
            "fax_number": "304-253-0018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 FAIRVIEW HEIGHTS RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511086",
            "telephone_number": "304-872-5213",
            "fax_number": "304-872-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDDY",
        "first_name": "MYRA",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "19575",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "19575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20150000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summersville, WV

Sources for this page

Verify at the official NPI Registry.