Individual provider Active NPI

Sharifeh Farasat, MD

  • Dermatology Physician
  • Bridgeport, WV
National Provider Identifier
1053553131
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
25886 Issued in WV
Practice address
120 Medical Park Dr
Suite 300
Bridgeport, WV 26330-9012
Phone
(304) 624-7200
Fax
(304) 624-0026
NPI assigned
Apr 3, 2009
Last updated
Jan 23, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Dermatology Physician 207N00000X A123744 CA
Dermatology Physician 207N00000X 25886 WV Primary

Addresses

Primary practice location

120 Medical Park Dr
Suite 300
Bridgeport, WV 26330-9012

Mailing address

120 Medical Park Dr
Suite 300
Bridgeport, WV 26330-9012
Phone (304) 624-7200

Other identifiers 1

IdentifierTypeStateIssuer
3810027666MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140908002436 WV Practitioner - Dermatology 5597905810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Johns Hopkins University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain State Medical Specialties PLLCGroup PAC ID 9335046754, 38 clinicians

Practice addresses (Care Compare)

120 Medical Park Dr
Suite 200
Bridgeport, WV 26330-9013
Phone (304) 624-7200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.43 of 100Reported as group
Quality
88.74
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision15
Removal of tissue1-10
Removal of skin lesions588
Removal of nail tissue1-10
Removal or shaving of skin growth19
Skin biopsy443

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain State Medical Specialties, PLLC Dermatology CurrentSince Aug 25, 2014 Accepting new patients

Locations

120 Medical Park Dr
Ste 200
Bridgeport, WV 26330
Phone (304) 624-7200

165 Scott Ave
Ste 100
Morgantown, WV 26508
Phone (304) 554-0400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1238716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1053553131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR",
            "address_2": "SUITE 300",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309012",
            "telephone_number": "304-624-7200",
            "fax_number": "304-624-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEDICAL PARK DR",
            "address_2": "SUITE 300",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309012",
            "telephone_number": "304-624-7200",
            "fax_number": "304-624-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARASAT",
        "first_name": "SHARIFEH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-03",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A123744",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WV",
            "license": "25886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810027666",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, WV

Sources for this page

Verify at the official NPI Registry.