NPIMap

Individual provider Active NPI

Stephanus Johannes Serfontein, MD

  • Internal Medicine Physician
  • PT Pleasant, WV
National Provider Identifier
1154420990
Registry record updated Dec 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21778 Issued in WV
Practice address
2418 Jefferson Ave
PT Pleasant, WV 25550-1528
Phone
(304) 675-6835
Fax
(304) 675-6849
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21778 WV Primary

Addresses

Primary practice location

2418 Jefferson Ave
PT Pleasant, WV 25550-1528

Mailing address

3200 Maccorkle Seave B16
Charleston, WV 25304-1227
Phone (304) 388-5848

Other identifiers 2

IdentifierTypeStateIssuer
2548390MedicaidOH
3810001774MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050408000045 WV Practitioner - HospitalistPractitioner - Internal Medicine 6901853290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1400 Hospital Dr
Hurricane, WV 25526-9202
Phone (304) 757-1700

400 Association Dr
Suite 102
Charleston, WV 25311-1298

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

3200 Maccorkle Ave SE
#B16
Charleston, WV 25304
Phone (304) 388-5848

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

Organizations & group practices 3

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 11

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450742400000",
    "number": "1154420990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE SEAVE B16",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5848",
            "fax_number": "304-388-9654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 JEFFERSON AVE",
            "city": "PT PLEASANT",
            "state": "WV",
            "postal_code": "255501528",
            "telephone_number": "304-675-6835",
            "fax_number": "304-675-6849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERFONTEIN",
        "first_name": "STEPHANUS",
        "middle_name": "JOHANNES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2015-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "21778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2548390",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001774",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in PT Pleasant, WV

Sources for this page

Verify at the official NPI Registry.