NPIMap

Individual provider Active NPI

Jennifer Nicole Rose, D.O.

  • Family Medicine Physician
  • Lewisburg, WV
National Provider Identifier
1003175993
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2724 Issued in WV
Practice address
1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone
(304) 645-3220
Fax
(844) 479-4545
NPI assigned
May 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2724 WV Primary

Addresses

Primary practice location

1464 Jefferson St N
Lewisburg, WV 24901-1380

Mailing address

1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone (304) 645-3220

Other identifiers 1

IdentifierTypeStateIssuer
3810029042MedicaidWV

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
I20150116000418 WV Practitioner - Family Practice 4587817242 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Virginia School of Osteopathic Medicine Clinic IncGroup PAC ID 0941113427, shared by 2 NPIs, 33 clinicians

Practice addresses (Care Compare)

1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone (304) 645-3220

Hospital & facility affiliations

  • Home Care Plus, Incorporated Home health agency, Lewisburg, WV, CCN 517051
  • Adoration Home Health Home health agency, Charleston, WV, CCN 517115
  • Camc Greenbrier Valley Medical Center, Inc Hospital, Ronceverte, WV, CCN 510002
  • Pocahontas Memorial Hospital Hospital, Buckeye, WV, CCN 511314
  • Lewisgale Hospital Alleghany Hospital, Low Moor, VA, CCN 490126
  • Princeton Community Hospital Assn Inc Hospital, Princeton, WV, CCN 510046
  • Summersville Regional Medical Center Hospital, Summersville, WV, CCN 511322

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia School of Osteopathic Medicine Clinic Inc Family Medicine CurrentSince Jun 23, 2021 Accepting new patients
West Virginia School of Osteopathic Medicine Clinic Inc D/B/a Robert C. Byrd Clinic Family Medicine CurrentSince Nov 1, 2020 Accepting new patients

Locations

1464 Jefferson St N
Lewisburg, WV 24901
Phone (304) 647-5577

Interoperability endpoints

  • FHIR API: https://fhir.yourcareuniverse.net/tenant/8a5128d7-2d67-4c98-bf01-874e7ae0d5a9
  • Direct secure messaging: jennifer.rose.1@17660.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Robert C Byrd ClinicLewisburg, WV, CCN 513920 Rural health clinic Corporate Director Dec 20, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1003175993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-11",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "2724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810029042",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisburg, WV

Sources for this page

Verify at the official NPI Registry.