Mountain State Diabetes PLLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

MOUNTAIN STATE DIABETES PLLC

Practice address

1900 Garfield Ave Ste a
Parkersburg, WV 26101-2565

Phone

(877) 377-8427

Fax

(304) 699-0396

NPI assigned

Feb 7, 2020

Last updated

Nov 30, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Neal Pickering, DONPI 1932412442

Title

Owner

Phone

(877) 377-8427

Specialties & licenses 1

Addresses

Other names 1

• Mountain State Diabetes Other name

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

Practitioners 4

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.

• David Neal Pickering, D.O.

  • Internal Medicine Physician
  • Parkersburg, WV
  • NPI 1932412442

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Dana R Cruse, CFNP, BC-ADM

  • Family Nurse Practitioner
  • Parkersburg, WV
  • NPI 1932482874
  Medicare reassignment Care Compare group NPD
• Catherine Ensinger, PA-C

  • Physician Assistant
  • Parkersburg, WV
  • NPI 1053076448
  Medicare reassignment Care Compare group
• Brandon Matthew Wolfe, DO

  • Family Medicine Physician
  • Parkersburg, WV
  • NPI 1760493043
  NPD (past)

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

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1548892532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 GARFIELD AVE STE A",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261012565",
            "telephone_number": "877-377-8427",
            "fax_number": "304-699-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 GARFIELD AVE STE A",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261012565",
            "telephone_number": "877-377-8427",
            "fax_number": "304-699-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE DIABETES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-07",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "PICKERING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "NEAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-377-8427",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain State Diabetes",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mountain State Diabetes",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Endocrinology, Diabetes & Metabolism Physician in Parkersburg, WV
• Providers in Parkersburg, WV by specialty
• Endocrinology, Diabetes & Metabolism Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; 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.