NPIMap

Organization Active NPI

East Mountain Health Physicians, Inc.

Doing business as Valley Health Berkeley Family Medicine

  • Family Medicine Physician
  • Martinsburg, WV
National Provider Identifier
1073096566
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Doing business as
Valley Health Berkeley Family Medicine
Practice address
101 Marcley Dr
Martinsburg, WV 25401-2977
Phone
(304) 263-8911
NPI assigned
Sep 11, 2018
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST MOUNTAIN HEALTH PHYSICIANS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Renee Nevada Johnson
Title
Credentialing Coordinator
Phone
(540) 536-0103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

101 Marcley Dr
Martinsburg, WV 25401-2977

Mailing address

220 Campus Blvd Ste 100
Winchester, VA 22601-2896
Phone (540) 536-5100

Other names 1

  • Valley Health Berkeley Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170425001245 WV Part B Supplier - Clinic/Group Practice 9133405327 Receives reassigned benefits from 160 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ranson, WV; Hedgesville, WV; Martinsburg, WV; Inwood, WV; Baker, WV

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
East Mountain HLTH Phys Inc7 organizations share this tax ID, including this one
Part of
East Mountain HLTH Phys Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

97 Administrative Dr
Martinsburg, WV 25404
Phone (304) 350-3200

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1073096566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CAMPUS BLVD STE 100",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012896",
            "telephone_number": "540-536-5100",
            "fax_number": "540-536-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MARCLEY DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254012977",
            "telephone_number": "304-263-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MOUNTAIN HEALTH PHYSICIANS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MOUNTAIN HEALTH PHYSICIANS, INC.",
        "enumeration_date": "2018-09-11",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "NEVADA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "540-536-0103"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Health Berkeley Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Health Berkeley Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.