NPIMap

Organization Active NPI

Mountain State Medical Associates PLLC

  • Internal Medicine Physician
  • Charleston, WV
National Provider Identifier
1447349238
Registry record updated Nov 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20410 Issued in WV
Legal business name
MOUNTAIN STATE MEDICAL ASSOCIATES PLLC
Practice address
300 Kenton Dr
Suite 100
Charleston, WV 25311-1263
Phone
(304) 346-5533
Fax
(304) 346-5611
NPI assigned
Oct 12, 2006
Last updated
Nov 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2015

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

Authorized official

Name
Justin Dale Bailey, MDNPI 1992784243
Title
President
Phone
(304) 346-5533

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
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 20410 WV Primary

Addresses

Primary practice location

300 Kenton Dr
Suite 100
Charleston, WV 25311-1263

Mailing address

300 Kenton Dr
Suite 100
Charleston, WV 25311-1263
Phone (304) 346-5533

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041117000293 WV Part B Supplier - Clinic/Group Practice 8921062183 Receives reassigned benefits from 6 practitioners
Practice locations: Charleston, WV

National Provider Directory

National Provider Directory

Locations

300 Kenton Dr
Ste 100
Charleston, WV 25311
Phone (304) 346-5533

Practitioners & affiliated clinicians

Practitioners 7

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1447349238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 KENTON DR",
            "address_2": "SUITE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111263",
            "telephone_number": "304-346-5533",
            "fax_number": "304-346-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 KENTON DR",
            "address_2": "SUITE 100",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111263",
            "telephone_number": "304-346-5533",
            "fax_number": "304-346-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE MEDICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-346-5533",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "20410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.