NPIMap

Organization Active NPI

Martinsburg Internal Medicine Assoc Inc

  • Internal Medicine Physician
  • Martinsburg, WV
National Provider Identifier
1558323006
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARTINSBURG INTERNAL MEDICINE ASSOC INC
Practice address
1002 Sushruta Dr
Martinsburg, WV 25401-8897
Phone
(304) 263-0913
Fax
(304) 267-2917
NPI assigned
Apr 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jesse Brian Jalazo, MDNPI 1134181688
Title
President
Phone
(304) 263-0913

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X WV Primary

Addresses

Primary practice location

1002 Sushruta Dr
Martinsburg, WV 25401-8897

Mailing address

1002 Sushruta Dr
Martinsburg, WV 25401-8897
Phone (304) 263-0913

Other identifiers 1

IdentifierTypeStateIssuer
0008030000MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558323006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 SUSHRUTA DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254018897",
            "telephone_number": "304-263-0913",
            "fax_number": "304-267-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 SUSHRUTA DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254018897",
            "telephone_number": "304-263-0913",
            "fax_number": "304-267-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTINSBURG INTERNAL MEDICINE ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JALAZO",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-263-0913",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008030000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.