NPIMap

Organization Active NPI

Rheumatology and Pulmonary Clinic PLLC

  • Specialist
  • Beckley, WV
National Provider Identifier
1467439463
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
17491 Issued in WV
Legal business name
RHEUMATOLOGY AND PULMONARY CLINIC PLLC
Practice address
421 Carriage Dr
Beckley, WV 25801-2805
Phone
(304) 256-0242
Fax
(304) 256-0244
NPI assigned
Dec 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

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

Authorized official

Name
Mrs. Becky S Fondale
Title
Office Manager
Phone
(304) 256-0242

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 17491 WV Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 18402 WV

Addresses

Primary practice location

421 Carriage Dr
Beckley, WV 25801-2805

Mailing address

421 Carriage Dr
Beckley, WV 25801-2805
Phone (304) 256-0242

Other identifiers 3

IdentifierTypeStateIssuer
1801602000MedicaidWV
001711048OtherWVBLUE CROSS
1805604000MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071221000492 WV Part B Supplier - Clinic/Group Practice 0446340822 Receives reassigned benefits from 7 practitioners
Practice locations: Beckley, WV

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2057222Rheumatology & Pulmonary Clinic421 Carriage Drive, Beckley, WV 25801ComplianceSep 22, 2027

National Provider Directory

National Provider Directory

Locations

421 Carriage Dr
Ste 417
Beckley, WV 25801
Phone (304) 256-0242

421 Carriage Dr
Beckley, WV 25801
Phone (304) 202-1993

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1467439463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-256-0242",
            "fax_number": "304-256-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 CARRIAGE DR",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012805",
            "telephone_number": "304-256-0242",
            "fax_number": "304-256-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RHEUMATOLOGY AND PULMONARY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-30",
        "last_updated": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "FONDALE",
        "authorized_official_first_name": "BECKY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-256-0242",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "17491",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "18402",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801602000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "001711048",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1805604000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; 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.