Individual provider Active NPI

Charles Wesley Clements II, MD

  • Family Medicine Physician
  • Huntington, WV
National Provider Identifier
1205897212
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19611 Issued in WV
Practice address
1600 Medical Center Dr
Suite 1500
Huntington, WV 25701-3656
Phone
(304) 691-1100
Fax
(304) 691-1183
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19611 WV Primary

Addresses

Primary practice location

1600 Medical Center Dr
Suite 1500
Huntington, WV 25701-3656

Mailing address

1600 Medical Center Dr
Suite 1500
Huntington, WV 25701-3656
Phone (304) 691-1100

Other identifiers 3

IdentifierTypeStateIssuer
64010614MedicaidKY
2157259MedicaidOH
5630273000MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address charles.clements@marshall.cernerdirect.com

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
I20051228000212 WV Practitioner - Family Practice 1557383072 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians & Surgeons, Inc. CurrentSince Jul 1, 1999 Accepting new patients
University Physicians & Surgeons, Inc Family Medicine CurrentSince Jul 1, 1999 Accepting new patients

Locations

1249 15th St
#4093
Huntington, WV 25701

1600 Medical Center Dr
Ste 1500
Huntington, WV 25701
Phone (304) 691-1100

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

1600 Medical Center Dr
#B51
Huntington, WV 25701
Phone (304) 691-8850

1600 Medical Center Dr
Huntington, WV 25701
Phone (304) 691-1100

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1205897212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 MEDICAL CENTER DR",
            "address_2": "SUITE 1500",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013656",
            "telephone_number": "304-691-1100",
            "fax_number": "304-691-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 MEDICAL CENTER DR",
            "address_2": "SUITE 1500",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013656",
            "telephone_number": "304-691-1100",
            "fax_number": "304-691-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTS",
        "first_name": "CHARLES",
        "middle_name": "WESLEY",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "19611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64010614",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2157259",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5630273000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charles.clements@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1600 Medical Center Dr",
            "address_2": "Suite 1500",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257013656",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

Verify at the official NPI Registry.