NPIMap

Organization Active NPI

Bluefield Gastroenterology PLLC

  • Specialist
  • Princeton, WV
National Provider Identifier
1093869968
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
BLUEFIELD GASTROENTEROLOGY PLLC
Practice address
405 12TH Street Ext
Princeton, WV 24740-2300
Phone
(304) 425-7243
Fax
(304) 487-3525
NPI assigned
Jan 22, 2007
Last updated
Nov 21, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Authorized official

Name
Mr. Kamalesh P Patel, M.D.NPI 1750472817
Title
Owner
Phone
(304) 425-7243

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

405 12TH Street Ext
Princeton, WV 24740-2300

Mailing address

405 12TH Street Ext
Princeton, WV 24740-2300
Phone (304) 425-7243

Other identifiers 3

IdentifierTypeStateIssuer
1807132OtherWVBLUECROSS BLUESHIELD
3810004352MedicaidWV
CK3736OtherWVRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040519001205 WV Part B Supplier - Clinic/Group Practice 5799776738 Receives reassigned benefits from 8 practitioners
Practice locations: Princeton, WV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D1053915Bluefield Gastroenterology PLLC405 12TH Street Extention, Princeton, WV 24740ComplianceMar 22, 2028

National Provider Directory

National Provider Directory

Locations

12 Westwood Medical Park
#8
Bluefield, VA 24605
Phone (276) 326-2011

512 Cherry St
Ste 1
Bluefield, WV 24701
Phone (304) 324-2715

405 12th Street Ext
Princeton, WV 24740
Phone (304) 324-2733

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195603200000",
    "number": "1093869968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 12TH STREET EXT",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402300",
            "telephone_number": "304-425-7243",
            "fax_number": "304-487-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 12TH STREET EXT",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402300",
            "telephone_number": "304-425-7243",
            "fax_number": "304-487-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEFIELD GASTROENTEROLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-11-21",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "KAMALESH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-425-7243",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "1807132",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004352",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK3736",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.