NPIMap

Organization Active NPI

Stateline Heart and Vascular Health, Inc

  • Cardiovascular Disease Physician
  • Martinsville, VA
National Provider Identifier
1306361803
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
0101230554 Issued in VA
Legal business name
STATELINE HEART AND VASCULAR HEALTH, INC
Practice address
312 Fairy Street Ext Ste 101
Martinsville, VA 24112-1912
Phone
(757) 813-6493
NPI assigned
Aug 7, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Deepak Dilip Banerjee, MDNPI 1437117579
Title
President
Phone
(757) 813-6493

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 0101230554 VA Primary

Addresses

Primary practice location

312 Fairy Street Ext Ste 101
Martinsville, VA 24112-1912

Mailing address

20 Hunt Country Farms Rd
Martinsville, VA 24112-6622
Phone (757) 813-6493

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180202001016 VA Part B Supplier - Clinic/Group Practice 9931469319 Receives reassigned benefits from 10 practitioners
Practice locations: Martinsville, VA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16877/brand/1/csg/1/fhir/r4

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": "1502064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306361803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 HUNT COUNTRY FARMS RD",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241126622",
            "telephone_number": "757-813-6493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 FAIRY STREET EXT STE 101",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241121912",
            "telephone_number": "757-813-6493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELINE HEART AND VASCULAR HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-07",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BANERJEE",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_middle_name": "DILIP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-813-6493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101230554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.