Active NPI
Jeffrey David Coffman, DDS
- General Practice Dentistry
- Buckhannon, WV
National Provider Identifier
1407933500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3582
- Practice address
- 14 N Spring St
Buckhannon, WV 26201-2720 - Phone
- (304) 472-1122
- Fax
- (304) 472-1939
- NPI assigned
- Nov 1, 2006
- Last updated
- Feb 8, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3582 | WV | Primary |
Addresses
Primary practice location
14 N Spring St
Buckhannon, WV 26201-2720
Mailing address
14 N Spring St
Buckhannon, WV 26201-2720
Phone (304) 472-1122
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810000801 | Medicaid | WV | |
| 3582 | Other | WV | STATE TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160211001506 | WV | Order and Referring Only - Dentist | 6305140369 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3582 | WV | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coffman and Hinkle, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454889600000",
"number": "1407933500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 N SPRING ST",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262012720",
"telephone_number": "304-472-1122",
"fax_number": "304-472-1939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 N SPRING ST",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262012720",
"telephone_number": "304-472-1122",
"fax_number": "304-472-1939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COFFMAN",
"first_name": "JEFFREY",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2016-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "3582",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810000801",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE TAX ID",
"identifier": "3582",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buckhannon, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.