NPIMap

Organization Active NPI

East Mountain Health Physicians, Inc.

  • Family Medicine Physician
  • Petersburg, WV
National Provider Identifier
1093219628
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAST MOUNTAIN HEALTH PHYSICIANS, INC.
Practice address
100 Hospital Dr Ste 1
Petersburg, WV 26847-9570
Phone
(304) 257-1944
Fax
(304) 257-9524
NPI assigned
Mar 20, 2018
Organization subpart
Yes
Parent organization
EAST MOUNTAIN HEALTH PHYSICIANS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X WV
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X

Addresses

Primary practice location

100 Hospital Dr Ste 1
Petersburg, WV 26847-9570

Mailing address

220 Campus Blvd Ste 200
Winchester, VA 22601-2889
Phone (540) 536-5100

Other names 1

  • Bensenhaver Medical Practice 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
Part of
East Mountain Health Physicians Inc

Locations

4803 Gerrardstown Rd
Inwood, WV 25428
Phone (304) 821-9011

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1093219628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CAMPUS BLVD STE 200",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012889",
            "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": "100 HOSPITAL DR STE 1",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479570",
            "telephone_number": "304-257-1944",
            "fax_number": "304-257-9524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MOUNTAIN HEALTH PHYSICIANS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST MOUNTAIN HEALTH PHYSICIANS, INC.",
        "enumeration_date": "2018-03-20",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bensenhaver Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; 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.