NPIMap

Organization Active NPI

South Branch Hospitalist and Internal Medicine Group PLLC

  • Internal Medicine Physician
  • Petersburg, WV
National Provider Identifier
1194232801
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOUTH BRANCH HOSPITALIST AND INTERNAL MEDICINE GROUP PLLC
Practice address
65 Hospital Dr Ste 102
Petersburg, WV 26847-9549
Phone
(304) 257-2527
Fax
(304) 257-1469
NPI assigned
Jan 3, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

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

Authorized official

Name
Dr. Caroline Armstrong, DONPI 1265758585
Title
Physician
Phone
(304) 257-2527

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X WV Primary
Hospitalist PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208M00000X WV
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X WV

Addresses

Primary practice location

65 Hospital Dr Ste 102
Petersburg, WV 26847-9549

Mailing address

PO Box 158
Petersburg, WV 26847-0158
Phone (304) 257-2527

Other identifiers 4

IdentifierTypeStateIssuer
0084630000MedicaidWV
3910007251MedicaidWV
0075837000MedicaidWV
3910000537MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180314000033 WV Part B Supplier - Clinic/Group Practice 9032471917 Receives reassigned benefits from 9 practitioners
Practice locations: Petersburg, WV

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2230652South Branch Hospitalist and Internal Medicine65 Hospital Drive, Suite 102, Petersburg, WV 26847Certificate of waiverJul 26, 2027

National Provider Directory

National Provider Directory

Locations

65 Hospital Dr
Ste 102
Petersburg, WV 26847
Phone (304) 257-2527

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1194232801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268470158",
            "telephone_number": "304-257-2527",
            "fax_number": "304-257-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 HOSPITAL DR STE 102",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479549",
            "telephone_number": "304-257-2527",
            "fax_number": "304-257-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BRANCH HOSPITALIST AND INTERNAL MEDICINE GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "304-257-2527",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "WV",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0084630000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3910007251",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075837000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3910000537",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.