James Namsupak, M.D.
Individual provider Active NPI General Practice Physician · Fairmont, WV
NPI 1043486145 · NPPES record last updated Sep 16, 2013
Key facts
- NPI
- 1043486145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 23919 (WV)
- Practice address
- 401 Guffey St
John Manchin Sr. Health Care Center
Fairmont, WV 26554-4029 - Phone
- (304) 363-2500
- NPI assigned
- May 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- West Virginia University School of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
401 Guffey St
Fairmont, WV 26554-4029
Phone (304) 363-2500
Hospital & facility affiliations
- West Virginia Caring
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100406000552 | WV | Practitioner - General Practice |
2264568971 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23919 | WV | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wvdhhr John Manchin Sr Health Care Center | Family Medicine | Current |
Accepting new patients |
| Manchin Wva Facility Operations LLC | Past | Accepting new patients | |
| Wvdhhr John Manchin Sr. Health Care Center | Past | Accepting new patients |
Locations
401 Guffey St
Fairmont, WV 26554
Phone (304) 363-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 23919 | WV | Yes |
| Family Medicine Physician | 207Q00000X | 23919 | WV |
Addresses
Primary practice location
401 Guffey St
John Manchin Sr. Health Care Center
Fairmont, WV 26554-4029
Mailing address
401 Guffey St
Fairmont, WV 26554-4029
Phone (304) 363-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810016983 | Medicaid | WV |
Other providers in Fairmont, WV
- Mva X-Ray Fairmont Clinic
- Mva X-Ray Fairmont Clinic
- Donna Lynn Myers
- Natasha Myers
- Myeyedr Optometry of West Virginia, PLLC
- National Youth Advocate Program
- Teresa Nations
- Shannon Nease
- Jody Esther Nedrow
- Alex Neese
All providers in Fairmont, WV · General Practice Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.