Abc Pediatrics, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

731 Issued in WV

Legal business name

ABC PEDIATRICS, PLLC

Practice address

830 Pennsylvania Ave
Suite 200
Charleston, WV 25302-3302

Phone

(304) 343-1863

Fax

(304) 344-1755

NPI assigned

Sep 21, 2006

Last updated

Jun 23, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Joseph Matusic, M.D.

Title

Physician

Phone

(304) 343-1863

Specialties & licenses 7

Addresses

Other identifiers 11

Tax ID family

Abc Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Abc Pediatrics, PLLC

  • Pediatric Adolescent Medicine Physician
  • Charleston, WV
  • NPI 1821338047
  NPD tax ID

Practitioners 2

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.

• Jennifer Divita, D.O.

  • Pediatrics Physician
  • Charleston, WV
  • NPI 1063646529
  NPD (past)
• Penny S Divita, DO

  • Pediatrics Physician
  • Charleston, WV
  • NPI 1598744757
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1154429041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 PENNSYLVANIA AVE",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253023302",
            "telephone_number": "304-343-1863",
            "fax_number": "304-344-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 PENNSYLVANIA AVE",
            "address_2": "SUITE 200",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253023302",
            "telephone_number": "304-343-1863",
            "fax_number": "304-344-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABC PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "MATUSIC",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "304-343-1863",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "51D0910134",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "18804",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "1451",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "15140",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "18217",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "16381",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0107822000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # PENNY DIVITA,DO",
            "identifier": "1598744757",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112455000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI# BRENDA WALKER,CFNP",
            "identifier": "1013971761",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0167011000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003000000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # CAROL FRAIL, MD",
            "identifier": "1295798361",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4000022000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUE ANN UPTON,MD NPI #",
            "identifier": "1922061076",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105170000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # JOE MATUSIC, MD",
            "identifier": "1912961343",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 699 South Park Road Operations LLC (Quarry Manor)
• 7 Summit Pathways
• Brenda Abati
• Cassie L Abbott
• Jennifer L Abbott, MAT
• Abc Pediatrics, PLLC
• Abdallah Dalabih
• Ra'Ed 'Ed' Joseph Abdel-Hadi
• Ibrahem F Abdou
• Keona Abdul-Alim

• Pediatrics Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Pediatrics Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.