Organization Active NPI

Neighborhood Family Medicine PLLC

  • Family Medicine Physician
  • Elkins, WV
National Provider Identifier
1285813428
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
WV 1917 Issued in WV
Legal business name
NEIGHBORHOOD FAMILY MEDICINE PLLC
Practice address
630 Robert E Lee Ave
Elkins, WV 26241-3211
Phone
(304) 637-8907
Fax
(304) 637-3592
NPI assigned
Oct 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mrs. Jennifer Jo Roberts
Title
Office Manager
Phone
(304) 637-8907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X WV 1917 WV Primary

Addresses

Primary practice location

630 Robert E Lee Ave
Elkins, WV 26241-3211

Mailing address

630 Robert E Lee Ave
Elkins, WV 26241-3211
Phone (304) 637-8907

Other identifiers 2

IdentifierTypeStateIssuer
DB5584OtherWVRAILROAD MEDICARE
3810011254MedicaidWV

National Provider Directory

National Provider Directory

Locations

630 Robert E Lee Ave
Elkins, WV 26241
Phone (304) 637-2326

Practitioners & affiliated clinicians

Practitioners 1

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": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1285813428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ROBERT E LEE AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413211",
            "telephone_number": "304-637-8907",
            "fax_number": "304-637-3592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ROBERT E LEE AVE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413211",
            "telephone_number": "304-637-8907",
            "fax_number": "304-637-3592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-637-8907",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "WV 1917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB5584",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011254",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkins, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.