Josiah Kenneth Lilly III, MD MS

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

11322 Issued in WV

Practice address

4001 Virginia Ave SE
Charleston, WV 25304-1603

Phone

(304) 925-2922

Fax

(304) 926-8009

NPI assigned

Apr 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Applachain Pain Therapy Institute

  • Interventional Pain Medicine Physician
  • Charleston, WV
  • NPI 1144340787
  NPD (past) Authorized official
• General Anesthesia Services Inc

  • Anesthesiology Physician
  • Charleston, WV
  • NPI 1811997869
  NPD (past)

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1376507566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 VIRGINIA AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041603",
            "telephone_number": "304-925-2922",
            "fax_number": "304-926-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 VIRGINIA AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041603",
            "telephone_number": "304-925-2922",
            "fax_number": "304-926-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "JOSIAH",
        "middle_name": "KENNETH",
        "name_suffix": "III",
        "credential": "MD MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "WV",
            "license": "11322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0201994",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krisena Light
• Angela Lilly
• Carmela Lilly
• Jaiden Lilly
• Jessica Lilly
• Karen Lilly
• Katie Jean Lilly, REGISTERED PHARM D.
• Micheal Lilly, DPT
• Morgan Lee Lilly, COTA
• Mystical Lilly

• Pain Medicine Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Pain Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.