Rogelio O Bantug, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

10665 Issued in WV

Practice address

314 S Wells St
Sistersville, WV 26175-1098

Phone

(304) 447-2030

Fax

(304) 652-1448

NPI assigned

Sep 22, 2005

Last updated

Aug 9, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1104812304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-447-2030",
            "fax_number": "304-652-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-447-2030",
            "fax_number": "304-652-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTUG",
        "first_name": "ROGELIO",
        "middle_name": "O",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "10665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rogelio.bantug@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "314 S Wells St",
            "city": "Sistersville",
            "state": "WV",
            "country_code": "US",
            "postal_code": "261751098",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rogelio.bantug@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "100 Fair St",
            "city": "Middlebourne",
            "state": "WV",
            "country_code": "US",
            "postal_code": "261499525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• 201 Wood Street Operations LLC (Sistersville Center)
• Saed A Ahmad, MD
• Trey Baker
• Tammy Lee Bassett
• Darrell Billiter
• Devin Michael Blair
• Anissa Paige Bohrer X
• Mandy Boswell

• Family Medicine Physician in Sistersville, WV
• Providers in Sistersville, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.