NPIMap

Individual provider Active NPI

Siwat Kiratiseavee, MD

  • Allergy & Immunology Physician
  • Charleston, WV
National Provider Identifier
1629280664
Registry record updated Jan 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
22761 Issued in WV
Practice address
208 Maccorkle Ave SE
Charleston, WV 25314-1160
Phone
(304) 343-4300
Fax
(304) 343-5473
NPI assigned
May 3, 2007
Last updated
Jan 3, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X P48044 NY
Allergy & Immunology Physician 207K00000X 22761 WV Primary

Addresses

Primary practice location

208 Maccorkle Ave SE
Charleston, WV 25314-1160

Mailing address

208 Maccorkle Ave SE
Charleston, WV 25314-1160
Phone (304) 343-4300

Other identifiers 1

IdentifierTypeStateIssuer
3810009489MedicaidWV

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
I20070815000477 WV Practitioner - Allergy/Immunology 9032201462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

208 Maccorkle Ave SE
Charleston, WV 25314-1160
Phone 304343430099

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.76 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
75.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P48044NYMDAllergy & Immunology Physician
22761WVMDAllergy & Immunology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
WV Asthma and Allergy Centers, Inc. Allergy & Immunology CurrentSince Jun 1, 2008 Accepting new patients
WV Asthma and Allergy Centers, Inc. Allergy & Immunology Current Accepting new patients

Locations

246 George St
Beckley, WV 25801
Phone (304) 253-7100

208 Maccorkle Ave SE
Charleston, WV 25314
Phone (304) 343-4300

118 Nick Savas Dr
Logan, WV 25601
Phone (304) 752-4045

418 Grand Park Dr
Ste 326
Parkersburg, WV 26105
Phone (304) 422-1400

598 Church St S
#A
Ripley, WV 25271
Phone (304) 372-3033

Organizations & group practices 2

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

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388707200000",
    "number": "1629280664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141160",
            "telephone_number": "304-343-4300",
            "fax_number": "304-343-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141160",
            "telephone_number": "304-343-4300",
            "fax_number": "304-343-5473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRATISEAVEE",
        "first_name": "SIWAT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2014-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NY",
            "license": "P48044",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "WV",
            "license": "22761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009489",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.