NPIMap

Individual provider Active NPI

Sidharth Jain, M.D.

  • Internal Medicine Physician
  • Charleston, WV
National Provider Identifier
1609290899
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
32595 Issued in WV
Practice address
3200 Maccorkle Ave SE Ste B-16
Charleston, WV 25304-1297
Phone
(304) 388-5848
Fax
(304) 388-9654
NPI assigned
Feb 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 32595 WV Primary

Addresses

Primary practice location

3200 Maccorkle Ave SE Ste B-16
Charleston, WV 25304-1297

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6400

Other practice location 1

811 S Washington Ave
Marshall, TX 75670-5336
Phone (903) 315-1488

Other practice location 2

700 E Marshall Ave
Longview, TX 75601
Phone (903) 315-1488

Other practice location 3

323 E Hawkins Pkwy
Longview, TX 75605-8153
Phone (903) 544-6700

Other practice location 4

1612 S Henderson Blvd
Kilgore, TX 75662-3518
Phone (903) 983-2492

Other practice location 5

800 E Dawson St
Tyler, TX 75701-2036
Phone (903) 606-4888

Other practice location 6

8389 S Broadway Ave
Tyler, TX 75703-5408
Phone (903) 606-4129

Other practice location 7

1631 11th Street
Unit B
Wichita Falls, TX 76301-7630
Phone (940) 263-3000

Other practice location 8

811 S Washington Ave
Marshall, TX 75670-5336
Phone (903) 315-1488

Other practice location 9

3421 W 9th St
Waterloo, IA 50702-5401
Phone (319) 272-8349

Other practice location 10

700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-1488

Other identifiers 1

IdentifierTypeStateIssuer
8KU309OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231114002847 WV Practitioner - Internal Medicine 1456576339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Area Medical Center IncGroup PAC ID 3375441637, 969 clinicians

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-7823

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

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
32595WVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Sergio Zamora, PA CurrentSince May 1, 2022 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Sep 18, 2023 Accepting new patients
United Regional Health Care System Inc Current Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Sep 18, 2023 Accepting new patients
Charleston Area Medical Center Inc PastSince Jul 16, 2023 Accepting new patients
Charleston Area Medical Center Inc PastSince Jul 16, 2023 Accepting new patients

Locations

2450 El Indio Hwy
Eagle Pass, TX 78852
Phone (210) 807-8796

1600 11th St
Wichita Falls, TX 76301
Phone (940) 263-3000

1631 11th St
Unit B
Wichita Falls, TX 76301
Phone (940) 263-3000

3200 Maccorkle Ave SE
Ste B16
Charleston, WV 25304
Phone (304) 388-5848

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

Interoperability endpoints

  • Direct secure messaging: sjain73025@unitedregional.medalliesdirect.net
  • Direct secure messaging: sjain239279@christushealth.direct-ci.net
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1609290899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE STE B-16",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041297",
            "telephone_number": "304-388-5848",
            "fax_number": "304-388-9654"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 S Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705336",
            "country_code": "US",
            "telephone_number": "903-315-1488",
            "fax_number": "903-315-1656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 E Marshall Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "75601",
            "country_code": "US",
            "telephone_number": "903-315-1488",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "323 E Hawkins Pkwy",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756058153",
            "country_code": "US",
            "telephone_number": "903-544-6700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1612 S Henderson Blvd",
            "address_purpose": "LOCATION",
            "city": "Kilgore",
            "state": "TX",
            "postal_code": "756623518",
            "country_code": "US",
            "telephone_number": "903-983-2492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 E Dawson St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012036",
            "country_code": "US",
            "telephone_number": "903-606-4888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8389 S Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757035408",
            "country_code": "US",
            "telephone_number": "903-606-4129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1631 11th Street",
            "address_2": "Unit B",
            "address_purpose": "LOCATION",
            "city": "Wichita Falls",
            "state": "TX",
            "postal_code": "763017630",
            "country_code": "US",
            "telephone_number": "940-263-3000",
            "fax_number": "940-263-3018",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "811 S Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705336",
            "country_code": "US",
            "telephone_number": "903-315-1488",
            "fax_number": "903-315-1656",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3421 W 9th St",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IA",
            "postal_code": "507025401",
            "country_code": "US",
            "telephone_number": "319-272-8349",
            "fax_number": "319-272-8355",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 E Marshall Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015580",
            "country_code": "US",
            "telephone_number": "903-315-1488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAIN",
        "first_name": "SIDHARTH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-10",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "32595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8KU309",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.