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Braddock Medical Group P.A.

Adult Medicine Physician in Fort Ashby, WV · enumerated 2007 · authorized official Paul Livengood, Owner.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1104962729

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Registry record

Entity type Organization (Type 2)
Legal business name Braddock Medical Group P.A.
Other name <Unavail>
Parent organization Braddock Medical Group PA
Practice address 70 Presidents Street, Unit 1150, Fort Ashby, WV, 26719
Phone (304) 298-3605
Fax (304) 298-3578
Enumeration date Jan 30, 2007
Last updated in NPPES Nov 1, 2016

Taxonomy & classification

207QA0505X Adult Medicine Physician Allopathic & Osteopathic Physicians · License 11172 (WV) Primary

Authorized official

Name Paul Livengood
Title Owner
Phone (304) 298-3605

Other identifiers

Identifier Type State Issuer
850-290 Other - MAMSI MDIPA OPTIMUM
H529BR Other MD BCBS GROUP #
W399 Other - BCBS FEDERAL PROVIDER #
00716943 Other WV BCBS PROVIDER #
41707101 Other MD BCBS PROVIDER #
3810000010 Medicaid WV -
0003 Other - BCBS FEDERAL GROUP #
0056043000 Medicaid WV -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for Braddock Medical Group P.A.?
NPPES lists Paul Livengood (Owner) as the authorized official for this organization.
What is the NPI number for Braddock Medical Group P.A.?
The NPI for Braddock Medical Group P.A. is 1104962729, a Type 2 (organization) record in the CMS NPPES registry.

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2016-11-01.