LIVING WATERS MEDICAL CENTER
NPI 1114585619
Clinic/Center - Primary Care in Logan, WV
About Living Waters Medical Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LIVING WATERS MEDICAL CENTER (NPI 1114585619) is a healthcare organization registered as a primary care in Logan, West Virginia and active in the NPI registry since May 2019. The organization holds a CLIA Waiver certificate valid through March 16, 2028 and lists Amber Ellis, Director/family Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Living Waters Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
8Medicare enrollment records show 8 clinicians reassign Medicare billing to Living Waters Medical Center, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (8)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 51D2168544
Living Waters Medical Center · Logan, WVFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Living Waters Medical Center's NPI number?
The NPI number for Living Waters Medical Center is 1114585619. It was assigned to this organization in the NPPES registry on May 31, 2019.
Where is Living Waters Medical Center located?
Living Waters Medical Center is located at 100 Main Ave, Logan, WV 25601. The listed phone number is (304) 946-8350.
What is Living Waters Medical Center's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Living Waters Medical Center enrolled in Medicare?
Yes. Living Waters Medical Center is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Living Waters Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 3 Medicare specialties reassign their Medicare billing to Living Waters Medical Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (5), Family Practice (2) and Mental Health Counselor (1). Of these, 1 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Living Waters Medical Center hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 51D2168544) is associated with this NPI, valid through March 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Living Waters Medical Center accept?
Health plans from CareSource and Highmark Blue Cross Blue Shield West Virginia list Living Waters Medical Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Living Waters Medical Center was last updated on March 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Living Waters Medical Center · NPI 1114585619
Primary Care organization in Logan, West Virginia. Organization record, active in the CMS NPPES registry since May 31, 2019.
## Identity
- **NPI:** 1114585619 (Entity type: Organization)
- **Enumerated:** May 31, 2019
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Amber Ellis, DIRECTOR/FAMILY NURSE PRACTITIONER
## Practice location
- **Address:** 100 MAIN AVE, Logan, WV 25601-3323
- **Phone:** (304) 946-8350
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 8 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (5), Family Practice (2), Mental Health Counselor (1); 1 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 26, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1114585619) · Data from the CMS NPPES public registry.