Medbrook Medical Associates Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MEDBROOK MEDICAL ASSOCIATES INC

Practice address

1370 Johnson Avenue
Bridgeport, WV 26330-1382

Phone

(304) 842-7186

Fax

(304) 842-9005

NPI assigned

May 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Tim G Bugin

Title

VP Payor Contracting

Phone

(304) 225-2500

Specialties & licenses 2

Addresses

Other identifiers 4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Saad Mossallati, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bridgeport, WV
  • NPI 1003900283
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329177600000",
    "number": "1013960632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "DELLSLOW",
            "state": "WV",
            "postal_code": "265310719",
            "telephone_number": "304-842-7186",
            "fax_number": "304-842-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 JOHNSON AVENUE",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301382",
            "telephone_number": "304-842-7186",
            "fax_number": "304-842-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDBROOK MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-02-14",
        "status": "A",
        "authorized_official_last_name": "BUGIN",
        "authorized_official_first_name": "TIM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP PAYOR CONTRACTING",
        "authorized_official_telephone_number": "304-225-2500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "01265",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "51D0925226",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID LAB",
            "identifier": "0010647002",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010647000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Margaret McQueen, BCBA
• Meadowbrook Counseling Services, LLC
• Meadowview Manor Health Care Center Inc.
• Med-Care LLC
• Medbrook Medical Assoc. Inc.
• Medbrook Medical Associates Inc (Medbrook Medical Associ Inc Phcy)
• Brandi N Medina
• Teodoro G Medina, M.D.
• Medstar Medical Supplies LLC
• Daniel James Merenda, MD

• Family Medicine Physician in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.