NPIMap

Individual provider Active NPI

Bernadette Luby, PA-C

  • Physician Assistant
  • Charleston, WV
National Provider Identifier
1982390282
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
870 Issued in WV
Practice address
4602 Maccorkle Ave SE
Charleston, WV 25304-1848
Phone
(304) 205-7535
Fax
(304) 205-7549
NPI assigned
Apr 11, 2023
Last updated
Sep 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9117743 FL
Physician Assistant 363A00000X 870 WV Primary

Addresses

Primary practice location

4602 Maccorkle Ave SE
Charleston, WV 25304-1848

Mailing address

104 Alex LN
Charleston, WV 25304-2952
Phone (304) 734-2040

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
I20230928000316 WV Practitioner - Physician Assistant 5496109217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cabin Creek Health Center IncGroup PAC ID 2466431101, 41 clinicians

Practice addresses (Care Compare)

107 Koontz Ave
Suite 200
Clendenin, WV 25045-9581
Phone (304) 548-7272

4602 Maccorkle Ave SE
Charleston, WV 25304-1848
Phone (304) 205-7535

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
870WVMDPsychologist
9117743FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cabin Creek Health Center, Inc. CurrentSince Oct 9, 2023 Accepting new patients
Cabin Creek Health Center, Inc. CurrentSince Oct 9, 2023 Accepting new patients
Cabin Creek Health Center, Inc. Past Accepting new patients

Locations

1 Warrior Way
Ste 103
Belle, WV 25015
Phone (304) 949-3591

104 Alex Ln
Charleston, WV 25304
Phone 30473420401319

4602 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 205-7535

6135 Sissonville Dr
Charleston, WV 25312
Phone (304) 343-8030

107 Koontz Ave
Ste 200
Clendenin, WV 25045
Phone (304) 548-7272

Interoperability endpoints

  • Direct secure messaging: bernadette.luby.1@7267.direct.athenahealth.com

Organizations & group practices 3

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 11

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": "1681171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1982390282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ALEX LN",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042952",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041848",
            "telephone_number": "304-205-7535",
            "fax_number": "304-205-7549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUBY",
        "first_name": "BERNADETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-11",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9117743",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.