Individual provider Active NPI

Kimberly J Fairley, DO

  • Gastroenterology Physician
  • Bridgeport, WV
National Provider Identifier
1114199411
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2422 Issued in WV
Practice address
527 Medical Park Dr Ste 402
Bridgeport, WV 26330-9010
Phone
(681) 342-3690
NPI assigned
Mar 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2422 WV Primary

Addresses

Primary practice location

527 Medical Park Dr Ste 402
Bridgeport, WV 26330-9010

Mailing address

527 Medical Park Dr Ste 402
Bridgeport, WV 26330-9010
Phone (681) 342-3690

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address kfairley5312@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address kfairley5312@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address kfairley5312@direct.wvuhsdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100616000982 WV Practitioner - GastroenterologyPractitioner - General PracticePractitioner - Internal MedicinePractitioner - Osteopathic Manipulative Medicine 6204966310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
United Hospital Center IncGroup PAC ID 8123936010, 290 clinicians

Practice addresses (Care Compare)

527 Medical Park Dr
Suite 402
Bridgeport, WV 26330-9010
Phone (681) 342-3690

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy136
Upper gastrointestinal (GI) endoscopy for acid reflux332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
United Hospital Center, Inc. Gastroenterology CurrentSince Mar 21, 2015 Accepting new patients
United Hospital Center CurrentSince Mar 21, 2015 Accepting new patients

Locations

527 Medical Park Dr
Ste 402
Bridgeport, WV 26330
Phone (681) 342-3690

527 Medical Park Dr
Bridgeport, WV 26330
Phone (304) 842-3993

916 W Main St
Bridgeport, WV 26330
Phone (304) 842-1034

327 Medical Park Dr
Bridgeport, WV 26330
Phone (681) 342-1000

2673 Davisson Run Rd
Ste 303
Clarksburg, WV 26301

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1114199411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR STE 402",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309010",
            "telephone_number": "681-342-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR STE 402",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309010",
            "telephone_number": "681-342-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-26",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WV",
            "license": "2422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfairley5312@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "527 Medical Park Dr Ste 402",
            "city": "Bridgeport",
            "state": "WV",
            "country_code": "US",
            "postal_code": "263309010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfairley5312@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "527 Medical Park Dr Ste 402",
            "city": "Bridgeport",
            "state": "WV",
            "country_code": "US",
            "postal_code": "263309010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kfairley5312@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "527 Medical Park Dr",
            "city": "Bridgeport",
            "state": "WV",
            "country_code": "US",
            "postal_code": "263309008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeport, WV

Sources for this page

Verify at the official NPI Registry.