Active NPI
Steven Kim Sidebottom, D.C.
- Internist Chiropractor
- Parkersburg, WV
National Provider Identifier
1689789117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internist Chiropractor
- License
- 306
- Practice address
- 293 College Pkwy
Parkersburg, WV 26104-7655 - Phone
- (304) 485-1251
- Fax
- (304) 485-0306
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internist Chiropractor | 111NI0900X | 306 | WV | Primary |
Addresses
Primary practice location
293 College Pkwy
Parkersburg, WV 26104-7655
Mailing address
293 College Pkwy
Parkersburg, WV 26104-7655
Phone (304) 485-1251
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0131692000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120130000270 | WV | Practitioner - Chiropractic | 0143487488 | Practice locations: Parkersburg, WV |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
293 College Pkwy
Parkersburg, WV 26104-7655
Phone (304) 485-1251
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 306 | WV | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385078400000",
"number": "1689789117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "293 COLLEGE PKWY",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261047655",
"telephone_number": "304-485-1251",
"fax_number": "304-485-0306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "293 COLLEGE PKWY",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261047655",
"telephone_number": "304-485-1251",
"fax_number": "304-485-0306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDEBOTTOM",
"first_name": "STEVEN",
"middle_name": "KIM",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2013-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "111NI0900X",
"taxonomy_group": "",
"desc": "Chiropractor, Internist",
"state": "WV",
"license": "306",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0131692000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Parkersburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.