NPIMap

Organization Active NPI

Associated Oral & Maxillofacial Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Martinsburg, WV
National Provider Identifier
1346310505
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ASSOCIATED ORAL & MAXILLOFACIAL SURGEONS, PC
Practice address
1007 Sushruta Drive
Martinsburg, WV 25401
Phone
(304) 263-0991
Fax
(304) 274-9546
NPI assigned
Nov 8, 2006
Last updated
Feb 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

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

Authorized official

Name
Pamela Phillips
Title
Office Manager
Phone
(304) 263-0991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X Primary

Addresses

Primary practice location

1007 Sushruta Drive
Martinsburg, WV 25401

Mailing address

1007 Sushruta Drive
Martinsburg, WV 25401
Phone (304) 263-0991

Other practice location 1

1144 Opal Ct
Hagerstown, MD 21740-5940
Phone (301) 733-2500 ext. 314

Other practice location 2

6550 Mercantile Dr E Ste 101
Frederick, MD 21703-7656
Phone (301) 694-0870

Other identifiers 1

IdentifierTypeStateIssuer
3810006011MedicaidWV

Other names 2

  • Drs. Russell, Pike & Nelson, PC Former legal business name
  • Drs. Russell, Pike, & Nelson, PC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040127000598 WV Part B Supplier - Clinic/Group Practice 1355243544 Receives reassigned benefits from 2 practitioners
Practice locations: Martinsburg, WV
O20050414000112 MD Part B Supplier - Clinic/Group Practice 1355243544 Receives reassigned benefits from 3 practitioners
Practice locations: Frederick, MD; Hagerstown, MD

National Provider Directory

National Provider Directory
Tax ID family
Associated Oral Maxillofacial Surgeons PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

198 Thomas Johnson Dr
Ste 101
Frederick, MD 21702
Phone (301) 694-0870

1007 Sushruta Dr
Martinsburg, WV 25401
Phone 3042630991 ext. 211

Practitioners & affiliated clinicians

Practitioners 11

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": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1346310505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 SUSHRUTA DRIVE",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "25401",
            "telephone_number": "304-263-0991",
            "fax_number": "304-274-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 SUSHRUTA DRIVE",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "25401",
            "telephone_number": "304-263-0991",
            "fax_number": "304-274-9546"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1144 Opal Ct",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217405940",
            "country_code": "US",
            "telephone_number": "301-733-2500 x314",
            "fax_number": "301-733-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6550 Mercantile Dr E Ste 101",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217037656",
            "country_code": "US",
            "telephone_number": "301-694-0870",
            "fax_number": "301-694-7034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ASSOCIATED ORAL & MAXILLOFACIAL SURGEONS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-263-0991"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006011",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Russell, Pike & Nelson, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Drs. Russell, Pike, & Nelson, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; 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.