NPIMap

Organization Active NPI

Mountaineer Home Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Cumberland, MD
National Provider Identifier
1356007785
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MOUNTAINEER HOME MEDICAL, LLC
Practice address
721 Park St
Cumberland, MD 21502-3172
Phone
(240) 410-1170
Fax
(240) 362-7089
NPI assigned
Nov 10, 2021
Last updated
May 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Authorized official

Name
Michelle Jackson
Title
Billing Manager
Phone
(304) 225-6290

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Customized Equipment (DME) 332BC3200X NU
Oxygen Equipment & Supplies (DME) 332BX2000X NU

Addresses

Primary practice location

721 Park St
Cumberland, MD 21502-3172

Mailing address

5000 Greenbag Rd Ste F6
Morgantown, WV 26501-7123
Phone (304) 225-6290

Other identifiers 2

IdentifierTypeStateIssuer
814066900MedicaidMD
5362500002OtherMDMD MEDICARE PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mjackson@mountaineerhomemedical.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220502000803 MD DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 0840400263 Practice locations: Cumberland, MD

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mountaineer Home Medical, LLC721 Park St, Cumberland, MD 21502-3172(240) 410-1170 Automatic Ext Defibrillator (AEDS) and/or Supplies|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Mail Order)|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Canes and/or Crutches|Patient Lifts|Power Operated Vehicles (Scooters)|Walker… Does not accept assignmentParticipating since Jan 20, 2005

National Provider Directory

National Provider Directory
Tax ID family
Mountaineer Home Medical LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

739 Park St
Ste 721
Cumberland, MD 21502

NPI Registry JSON

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1356007785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 GREENBAG RD STE F6",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265017123",
            "telephone_number": "304-225-6290",
            "fax_number": "304-225-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 PARK ST",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215023172",
            "telephone_number": "240-410-1170",
            "fax_number": "240-362-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER HOME MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "304-225-6290"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "814066900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD MEDICARE PTAN",
            "identifier": "5362500002",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjackson@mountaineerhomemedical.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5000 Greenbag Rd Ste F6",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265017123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cumberland, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; 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.