Burnsville Medical Center PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

17332 Issued in WV

Legal business name

BURNSVILLE MEDICAL CENTER PLLC

Practice address

110 Municipal Street
Burnsville, WV 26335-0424

Phone

(304) 853-2278

Fax

(304) 853-2520

NPI assigned

Apr 6, 2007

Last updated

Oct 5, 2010By 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. Antoine Katiny, MDNPI 1407816416

Title

Owner

Phone

(304) 853-2278

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Braxton Primary Health Care Other name

Medicare fee-for-service enrollment

Enrolled in WV2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619090743. Details of each certification follow.

• CCN 513884 Rural health clinic · Active · Details

Rural health clinic certification: CCN 513884

Legal name

BURNSVILLE MEDICAL CENTER PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 27, 1996

Last certification

Apr 13, 2022

Ownership / control type

1A

Organization structure

OtherProprietary

Enrollment address

110 Municipal Street
Braxton Primary Health Care
Burnsville, WV 26335-0424

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

CLIA laboratory certificates

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Antoine Katiny, MD

  • Internal Medicine Physician
  • Burnsville, WV
  • NPI 1407816416

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 2

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.

• Antoine Katiny, MD

  • Internal Medicine Physician
  • Burnsville, WV
  • NPI 1407816416
  Medicare reassignment Authorized official
• Nihit Gupta, M.D.

  • Child & Adolescent Psychiatry Physician
  • Liberty TWP, OH
  • NPI 1427337534
  NPD (past)

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1619090743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MUNICIPAL STREET",
            "address_2": "PO BOX 424",
            "city": "BURNSVILLE",
            "state": "WV",
            "postal_code": "263350424",
            "telephone_number": "304-853-2278",
            "fax_number": "304-853-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MUNICIPAL STREET",
            "city": "BURNSVILLE",
            "state": "WV",
            "postal_code": "263350424",
            "telephone_number": "304-853-2278",
            "fax_number": "304-853-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURNSVILLE MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "KATINY",
        "authorized_official_first_name": "ANTOINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-853-2278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "17332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0034771000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075944000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Braxton Primary Health Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kaitlyn Bollinger
• Burnsville Drug Store
• Community Care of West Virginia, Inc. (Burnsville Elementary School Wellness Center)
• Shadow Dobbins
• Kimberly Garrison
• Antoine Katiny, MD
• Peyton Lunceford

• Internal Medicine Physician in Burnsville, WV
• Providers in Burnsville, WV by specialty
• Internal Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.