DR. J. DEREK HOLLINGSWORTH (NPI# 1336192269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336192269 |
| Entity Type | Individual |
| Full Name | DR. J. DEREK HOLLINGSWORTH |
| Credential | D.O. |
| Practice Address |
6775 Point Pleasant Rd Millwood WV 25262-8100 |
| Practice Telephone | 3042730112 |
| Practice Fax Number | 3042730115 |
| Mailing Telephone | 3042730112 |
| Mailing Fax Number | 3042730115 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2016-12-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 2360 | WV | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 34007332 | OH | Allopathic & Osteopathic Physicians |
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
27036 | MT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ANTHEM BCBS | 000000205910 | 01 | |
| NPI | 1336192269 | 01 | |
| WV | 3002978000 | 05 | |
| MT | STATE LICENSE | 27036 | 01 |
| OH | UNISON MEDICAID | 000000185452 | 01 |
| MOUNTAIN STATE BCBS | 001714124 | 01 | |
| OH | MOLINA MEDICAID | 2246895 | 01 |
| RR MEDICARE | 930106977 | 01 | |
| OH | TRI CARE | 516066972 | 01 |
| Street Address |
6775 POINT PLEASANT RD |
| City | MILLWOOD |
| State | WV |
| Zip Code | 25262-8100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023553443 | Peggy Mccormick | Social Worker | 6775 Point Pleasant Rd, Millwood, WV 25262-8100 | 2016-12-20 |
| 1699127829 | West Virginia Rehabilitation Centers | Substance Abuse Rehabilitation Facility | 6775 Point Pleasant Rd, Millwood, WV 25262-8100 | 2016-07-12 |
| 1396103578 | Anthony Bell | Social Worker | 6775 Point Pleasant Rd, Millwood, WV 25262-8100 | 2016-02-03 |
| 1821462789 | Natalie Mcneely | Psychologist | 6775 Point Pleasant Rd, Millwood, WV 25262-8100 | 2015-11-16 |
| 1861432593 | Louis A Yancich | Personal Emergency Response Attendant | 6775 Point Pleasant Rd, Millwood, WV 25262-8100 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316552805 | Debra E Casto | Technician | 840 Woodland Dr, Millwood, WV 25262-8574 | 2020-09-10 |
| 1528381746 | Jackson County Developmental Center, Inc | Case Management | 270 Jack Burlingame Dr, Millwood, WV 25262-8576 | 2010-03-02 |
| 1265041529 | Jennifer Lyn Greening | Technician | 270 Jack Burlingame Dr, Millwood, WV 25262-8576 | 2020-07-23 |
| 1477169134 | Gary Hoskins | Technician | 284 Marties Dr, Millwood, WV 25262-8584 | 2020-09-18 |
| 1568920700 | Alexis Raelle Price | Specialist/Technologist, Other | 2240 Sugar Run Rd, Millwood, WV 25262-8614 | 2019-03-06 |
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750995734 | Sarah Nicole Stanley | Family Medicine | 31 Sandlewood Dr, Beckley, WV 25801-2358 | 2020-09-07 |
| 1942847975 | Recovery Care LLC | Family Medicine | 37 Carroll Avenue, Keyser, WV 26726 | 2019-12-10 |
| 1316438773 | Road To Recovery, LLC | Family Medicine | 111 Court St S, Ripley, WV 25271 | 2018-05-22 |
| 1356841100 | Harper Road Treatment Center LLC | Family Medicine | 1802 Harper Rd Ste 202, Beckley, WV 25801 | 2018-02-19 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1285013896 | Doctors Specialty Care | Family Medicine | 27 Trovato St, Suite Number 103, Bridgeport, WV 26330-7002 | 2015-05-28 |
| 1316354574 | New Lifeclinics Inc | Family Medicine | 3471 Ohio River Rd, Point Pleasant, WV 25550-4401 | 2014-07-18 |
| 1861829947 | Hamada E Mahmoud | Family Medicine | 5505 Us Route 60 East, Suite 175, Huntington, WV 25705-2058 | 2013-10-03 |
| 1972943785 | Phillip Bradley Hall | Family Medicine | 680 Genesis Blvd, Ste 201, Bridgeport, WV 26330-9135 | 2013-06-26 |
| 1336413335 | Rodney Michael Simpkins | Family Medicine | 131 Moorefield Pl, Scott Depot, WV 25560-9565 | 2012-03-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.