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AMANDA CROFT-DEHAGEN MD
NPI 1164216057
Student in an Organized Health Care Education/Training Program in Charleston, WV

Active since April 07, 2025PECOS Enrolled
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304(304) 388-8199(304) 388-8195 Get Directions Write a Review

NPPES record last updated: April 7, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Amanda Croft-dehagen Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA CROFT-DEHAGEN MD (NPI 1164216057) is an individual student in an organized health care education/training program in Charleston, West Virginia and active in the NPI registry since April 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164216057
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameAMANDA CROFT-DEHAGENCredential: MD
Location Address3200 MACCORKLE AVE SECharleston, WV 25304-1227
Mailing Address3200 Maccorkle Ave SeCharleston, WV 25304-1227 · (304) 388-8199 · Fax (304) 388-8195
Phone(304) 388-8199
Fax(304) 388-8195
Sole ProprietorYes
Enumeration DateApril 7, 2025
NPPES CertifiedApril 7, 2025
✔ NPI 1164216057 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
3200 MACCORKLE AVE SE, Charleston, WV 25304
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amanda Croft-dehagen Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAMERON DUBA DO
Emergency Medicine
3200 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-4172
WILLIAM JARRETT WISEMAN BSN, RN, CCRN-CMC
Registered Nurse
3200 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 993-1088
MS. BRENDA LOU KEEFER ANP
Nurse Practitioner (Family)
3200 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 925-3436
LOUISE NAYLOR
Nurse Anesthetist, Certified Registered
3200 MACCORKLE AVE SE
CHARSTON, WV 25304
Kanawha County (304) 388-4077
DR. JEFFREY V ASHLEY M.D.
Family Medicine
3200 MACCORKLE AVE SE, FIFTH FLOOR
CHARLESTON, WV 25304
Kanawha County (304) 388-4600
TIFFANY D. DUTTON CRNA
Nurse Anesthetist, Certified Registered
3200 MACCORKLE AVE SE, DEPT. OF SURGERY
CHARLESTON, WV 25304
Kanawha County (304) 388-5503
JENNIFER D VALDEZ
Nurse Anesthetist, Certified Registered
3200 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 388-5432
CHRISTOPHER S MULLINS
Nurse Anesthetist, Certified Registered
3200 MACCORKLE AVE SE
CHARLESTON, WV 25304
Kanawha County (304) 688-0228

Frequently 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 Amanda Croft-dehagen's NPI number?

The NPI number for Amanda Croft-dehagen is 1164216057. It was assigned to this individual provider in the NPPES registry on April 7, 2025.

Where is Amanda Croft-dehagen located?

Amanda Croft-dehagen practices at 3200 Maccorkle Ave SE, Charleston, WV 25304. The listed phone number is (304) 388-8199.

What is Amanda Croft-dehagen's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Amanda Croft-dehagen enrolled in Medicare?

Yes. Amanda Croft-dehagen is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Amanda Croft-dehagen was last updated on April 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.