NPIMap

Organization Active NPI

United Physicians Care Inc

Doing business as Bridgeport Physicians Care

  • Family Medicine Physician
  • Bridgeport, WV
National Provider Identifier
1619176302
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNITED PHYSICIANS CARE INC
Doing business as
Bridgeport Physicians Care
Practice address
1511 Johnson Ave
Ste 104
Bridgeport, WV 26330-1016
Phone
(304) 848-0702
Fax
(304) 848-0705
NPI assigned
Jul 13, 2007
Last updated
Jan 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

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

Authorized official

Name
Mr. John C Forester
Title
Chief Executive Officer
Phone
(304) 624-4655

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1511 Johnson Ave
Ste 104
Bridgeport, WV 26330-1016

Mailing address

686 South Pike St
Ste a
Shinnston, WV 26431-1043
Phone (304) 624-4655

Other identifiers 1

IdentifierTypeStateIssuer
3810009401MedicaidWV

Other names 1

  • Bridgeport Physicians Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040706001382 WV Part B Supplier - Clinic/Group Practice 6103814017 Receives reassigned benefits from 173 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksburg, WV; West Union, WV; Shinnston, WV; Salem, WV; Ronceverte, WV; Philippi, WV; Pennsboro, WV; Jane Lew, WV…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Accident Family Medicine24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Practitioners & affiliated clinicians

Practitioners 6

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": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1619176302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "686 SOUTH PIKE ST",
            "address_2": "STE A",
            "city": "SHINNSTON",
            "state": "WV",
            "postal_code": "264311043",
            "telephone_number": "304-624-4655",
            "fax_number": "304-624-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 JOHNSON AVE",
            "address_2": "STE 104",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301016",
            "telephone_number": "304-848-0702",
            "fax_number": "304-848-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED PHYSICIANS CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "FORESTER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "304-624-4655",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009401",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgeport Physicians Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.