NPIMap

Organization Active NPI

Eastern Panhandle Psychiatry, Inc

  • Community/Behavioral Health Agency
  • Martinsburg, WV
National Provider Identifier
1407930225
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
20620 Issued in WV
Legal business name
EASTERN PANHANDLE PSYCHIATRY, INC
Practice address
51 Street of Dreams
Martinsburg, WV 25403-1134
Phone
(304) 264-1442
Fax
(304) 264-4317
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Shahnoor Ali Khan, MDNPI 1346342458
Title
President
Phone
(703) 400-3433

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
Community/Behavioral Health Agency 251S00000X 20620 WV Primary

Addresses

Primary practice location

51 Street of Dreams
Martinsburg, WV 25403-1134

Mailing address

PO Box 4056
Martinsburg, WV 25402-4056
Phone (304) 264-1442

Other identifiers 4

IdentifierTypeStateIssuer
1346342458OtherWVINDIVIDUAL NPI
2000700000MedicaidWV
20620OtherWVWV LICENSE
D0064888OtherMDMD LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050321000594 WV Part B Supplier - Clinic/Group Practice 9931154176 Receives reassigned benefits from 9 practitioners
Practice locations: Martinsburg, WV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1407930225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4056",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254024056",
            "telephone_number": "304-264-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 STREET OF DREAMS",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254031134",
            "telephone_number": "304-264-1442",
            "fax_number": "304-264-4317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN PANHANDLE PSYCHIATRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-03-07",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHAHNOOR",
        "authorized_official_middle_name": "ALI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-400-3433",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WV",
            "license": "20620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1346342458",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2000700000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV LICENSE",
            "identifier": "20620",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "D0064888",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 7, 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.