Active NPI
Samuel Bjorn Booth
- Student in an Organized Health Care Education/Training Program
- Charleston, WV
National Provider Identifier
1740976968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 3200 Maccorkle Ave SE
Charleston, WV 25304-1227 - Phone
- (304) 388-4874
- NPI assigned
- Apr 12, 2023
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Mailing address
510 Equality Ave
Fairhope, AL 36532-2108
Phone (251) 300-1117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230711004602 | WV | Order and Referring Only - Vascular Surgery | 8325407117 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681257600000",
"number": "1740976968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 EQUALITY AVE",
"city": "FAIRHOPE",
"state": "AL",
"postal_code": "365322108",
"telephone_number": "251-300-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041227",
"telephone_number": "304-388-4874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "SAMUEL",
"middle_name": "BJORN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-12",
"last_updated": "2023-04-12",
"certification_date": "2023-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.