Southern WV Medical and Surgical Specialists PLLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

23770 Issued in WV

Legal business name

SOUTHERN WV MEDICAL AND SURGICAL SPECIALISTS PLLC

Practice address

206 Skylar Dr
Lewisburg, WV 24901-9383

Phone

(681) 318-3540

Fax

(877) 712-1319

NPI assigned

Jun 1, 2016

Organization subpart

No

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

Authorized official

Name

Justin Wayne Douglas, M.D.NPI 1326210857

Title

Owner/President

Phone

(304) 929-6930

Specialties & licenses 1

Addresses

Other names 1

• Southern WV ENT Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23310/brand/1/csg/1/fhir/r4

Practitioners 5

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

• Justin Wayne Douglas, MD

  • Otolaryngology Physician
  • Beckley, WV
  • NPI 1326210857
  Medicare reassignment Care Compare group NPD Authorized official
• Kendra Renee Burns, FNP-BC

  • Nurse Practitioner
  • Lewisburg, WV
  • NPI 1619548559
  Medicare reassignment Care Compare group NPD
• Jillian Leigh Douglas, D.O.

  • Endocrinology, Diabetes & Metabolism Physician
  • Lewisburg, WV
  • NPI 1851564256
  Medicare reassignment Care Compare group NPD
• Arnold Kaltreider Vaughn, R.D., L.D., C.D.E.

  • Registered Dietitian
  • Lewisburg, WV
  • NPI 1598882862
  Medicare reassignment Care Compare group NPD
• Stephanie L Hamilton, PAC

  • Physician Assistant
  • Beckley, WV
  • NPI 1669476057
  Medicare reassignment

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1497103386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5482",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258017506",
            "telephone_number": "304-929-6930",
            "fax_number": "304-929-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 SKYLAR DR",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249019383",
            "telephone_number": "681-318-3540",
            "fax_number": "877-712-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN WV MEDICAL AND SURGICAL SPECIALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "304-929-6930",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "WV",
            "license": "23770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern WV ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catrina L Smith
• Jase C Smith
• Trevor Dale Smith
• Wade Thomas Smith, APRN
• Amanda 3046451706 Sorrells
• Cameron Spence
• Joyce M Spencer
• Heather Spradlin
• Dennis Virgil Spry, PCA
• Brittani Stanley, PHARMD

• Otolaryngology Physician in Lewisburg, WV
• Providers in Lewisburg, WV by specialty
• Otolaryngology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; 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.