NPIMap

Organization Active NPI

WV Asthma and Allergy Centers, Inc.

  • Allergy & Immunology Physician
  • Charleston, WV
National Provider Identifier
1114005477
Registry record updated Apr 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
11875 Issued in WV
Legal business name
WV ASTHMA AND ALLERGY CENTERS, INC.
Practice address
208 Maccorkle Ave SE
Charleston, WV 25314-1160
Phone
(304) 343-4300
Fax
(304) 343-5473
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2020

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

Authorized official

Name
Mr. Jason C. TrustyNPI 1467566463
Title
Administrator
Phone
(304) 343-4300

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
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X 11875 WV Primary

Addresses

Primary practice location

208 Maccorkle Ave SE
Charleston, WV 25314-1160

Mailing address

208 Maccorkle Ave SE
Charleston, WV 25314-1160
Phone (304) 343-4300

Other identifiers 1

IdentifierTypeStateIssuer
3810011961MedicaidWV

Other names 2

  • Asthma & Allergy Center Doing business as
  • Asthma and Allergy Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080514000183 WV Part B Supplier - Clinic/Group Practice 8527137728 Receives reassigned benefits from 21 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beckley, WV; Charleston, WV; Logan, WV; Parkersburg, WV; Ripley, WV

National Provider Directory

National Provider Directory

Locations

246 George St
Beckley, WV 25801
Phone (304) 253-7100

401 6th Ave
#303D
Montgomery, WV 25136
Phone (304) 343-4300

418 Grand Park Dr
Ste 326
Parkersburg, WV 26105
Phone (304) 422-1400

418 Grand Park Dr
Bldg Iii
Parkersburg, WV 26105

Ownership & related parties

Other NPIs on the same Medicare enrollment 5

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

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1114005477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141160",
            "telephone_number": "304-343-4300",
            "fax_number": "304-343-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141160",
            "telephone_number": "304-343-4300",
            "fax_number": "304-343-5473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WV ASTHMA AND ALLERGY CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "TRUSTY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "304-343-4300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "WV",
            "license": "11875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011961",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Asthma & Allergy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Asthma and Allergy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.