NPIMap

Individual provider Active NPI

Amy E. Tickle, MD

  • Family Medicine Physician
  • Charleston, WV
National Provider Identifier
1992921217
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23020 Issued in WV
Practice address
3200 Maccorkle Ave SE
Suite 502
Charleston, WV 25304-1227
Phone
(304) 388-5848
Fax
(304) 388-9654
NPI assigned
Apr 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 23020 WV
Family Medicine Physician 207Q00000X 23020 WV Primary

Addresses

Primary practice location

3200 Maccorkle Ave SE
Suite 502
Charleston, WV 25304-1227

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
P01045604OtherWVMEDICARE RAILROAD
3810013834MedicaidWV

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
I20090105000038 WV Practitioner - Family Practice 4587726344 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Area Medical Center IncGroup PAC ID 3375441637, 969 clinicians

Practice addresses (Care Compare)

1400 Hospital Dr
Hurricane, WV 25526-9202
Phone (304) 757-1700

400 Association Dr
Suite 102
Charleston, WV 25311-1298

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022
  • Boone Memorial Hospital Hospital, Madison, WV, CCN 511313
  • Camc Plateau Medical Center, Inc Hospital, Oak Hill, WV, CCN 511317

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23020WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cabin Creek Health Center, Inc. CurrentSince Sep 10, 2013 Accepting new patients
Cabin Creek Health Center, Inc. CurrentSince Sep 10, 2013 Accepting new patients
Cabin Creek Health Center, Inc. Current Accepting new patients
Charleston Area Medical Center Inc CurrentSince Dec 1, 2015 Accepting new patients
Womencare, Inc CurrentSince Aug 1, 2017 Accepting new patients
Womencare, Inc Current Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Dec 1, 2015 Accepting new patients
Womencare, Inc CurrentSince Aug 1, 2017 Accepting new patients

Locations

3200 Maccorkle Ave SE
Ste 502
Charleston, WV 25304
Phone (304) 388-5848

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

116 Hills Plz
Charleston, WV 25387
Phone (304) 720-4446

3200 Maccorkle Ave SE
Ste B16
Charleston, WV 25304
Phone (304) 388-5848

3200 Maccorkle Ave SE
#C
Charleston, WV 25304
Phone (304) 347-1336

104 Alex Ln
Charleston, WV 25304
Phone 30473420401319

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

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

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

Organizations & group practices 8

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1992921217",
    "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": "3200 MACCORKLE AVE SE",
            "address_2": "SUITE 502",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5848",
            "fax_number": "304-388-9654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKLE",
        "first_name": "AMY",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WV",
            "license": "23020",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "23020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01045604",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810013834",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.