Individual provider Active NPI

Jeremy B Soule, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Bridgeport, WV
National Provider Identifier
1467560326
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
19264 Issued in WV
Practice address
16 Sterling Dr
Suite 102
Bridgeport, WV 26330-9132
Phone
(304) 326-2320
Fax
(304) 326-2323
NPI assigned
Aug 29, 2006
Last updated
Apr 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 20980 SC
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 19264 WV Primary

Addresses

Primary practice location

16 Sterling Dr
Suite 102
Bridgeport, WV 26330-9132

Mailing address

PO Box 763
Morgantown, WV 26507-0763
Phone (800) 541-4009

Other identifiers 1

IdentifierTypeStateIssuer
209802MedicaidSC

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jsoule107515@direct.wvuhsdirect.com Health Information Exchange (HIE)
Direct Messaging Address jsoule107515@direct.wvuhsdirect.com Health Information Exchange (HIE)

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110712000577 WV Practitioner - Endocrinology 1658346945 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20980SCMDEndocrinology, Diabetes & Metabolism Physician
19264WVMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Jul 1, 2021 Accepting new patients
Charleston Area Medical Center Inc Endocrinology, Diabetes & Metabolism CurrentSince Jul 1, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

3100 Maccorkle Ave SE
Ste 700
Charleston, WV 25304
Phone (304) 351-1500

3200 Maccorkle Ave SE
#C
Charleston, WV 25304
Phone (304) 347-1336

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

Organizations & group practices 3

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1467560326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 763",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265070763",
            "telephone_number": "800-541-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 STERLING DR",
            "address_2": "SUITE 102",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309132",
            "telephone_number": "304-326-2320",
            "fax_number": "304-326-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOULE",
        "first_name": "JEREMY",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "SC",
            "license": "20980",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WV",
            "license": "19264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209802",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsoule107515@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3100 MacCorkle Ave SE Ste 700",
            "city": "Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253041230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsoule107515@direct.wvuhsdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3100 MacCorkle Ave SE",
            "city": "Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253041223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeport, WV

Sources for this page

Verify at the official NPI Registry.