NPIMap

Organization Active NPI

United Hospital Center

Doing business as UHC Gastroenterology

  • Gastroenterology Physician
  • Bridgeport, WV
National Provider Identifier
1184940132
Registry record updated Nov 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
107 Issued in WV
Legal business name
UNITED HOSPITAL CENTER
Doing business as
UHC Gastroenterology
Practice address
527 Medical Park Dr Ste 402
Bridgeport, WV 26330-9010
Phone
(681) 342-3690
NPI assigned
Apr 15, 2010
Last updated
Nov 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2015

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

Authorized official

Name
Michael Tillman
Title
Ceo
Phone
(681) 342-1620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 107 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

Other identifiers 1

IdentifierTypeStateIssuer
3810021342MedicaidWV

Other names 1

  • UHC Gastroenterology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000802 WV Part B Supplier - Clinic/Group Practice 8123936010 Receives reassigned benefits from 473 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: White Hall, WV; Weston, WV; Summersville, WV; Nutter Fort, WV; Grafton, WV; Glenville, WV; Fairmont, WV; Elkins, WV…

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1184940132",
    "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": {
        "organization_name": "UNITED HOSPITAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "681-342-1620"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WV",
            "license": "107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810021342",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UHC Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.