NPIMap

Organization Active NPI

Mountaineer Home Medical, LLC

  • Oxygen Equipment & Supplies (DME)
  • Morgantown, WV
National Provider Identifier
1760474852
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
Legal business name
MOUNTAINEER HOME MEDICAL, LLC
Practice address
5000 Greenbag Road
Suite F6
Morgantown, WV 26501
Phone
(304) 225-6290
Fax
(304) 225-1115
NPI assigned
Aug 16, 2005
Last updated
Jul 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

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

Authorized official

Name
Ms. Michelle L Jackson
Title
Billing Manager
Phone
(304) 225-6290

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X CONTROLNUMBER72117 WV
Durable Medical Equipment & Medical Supplies 332B00000X 770649 WV
Customized Equipment (DME) 332BC3200X
Oxygen Equipment & Supplies (DME) 332BX2000X Primary

Addresses

Primary practice location

5000 Greenbag Road
Suite F6
Morgantown, WV 26501

Mailing address

5000 Greenbag Rd Ste F6
Morgantown, WV 26501-7123
Phone (304) 225-6290

Other identifiers 5

IdentifierTypeStateIssuer
001704877OtherWVBLUE CROSS BLUE SHIELD
DME315OtherWVHEALTH PLAN PROVIDER #
3810001835MedicaidWV
407251100MedicaidMD
101294177 0001MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mjackson@mountaineerhomemedical.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930020756 WV DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 0840400263 Practice locations: Morgantown, WV

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mountaineer Home Medical, LLC5000 Greenbag Rd, Morgantown, WV 26501-7123(304) 225-6290 Automatic Ext Defibrillator (AEDS) and/or Supplies|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Canes and/or Crutches|Patient Lifts|Power Operated V… Does not accept assignmentParticipating since Jan 20, 2005

National Provider Directory

National Provider Directory
Tax ID family
Mountaineer Home Medical LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784678400000",
    "number": "1760474852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 GREENBAG RD STE F6",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265017123",
            "telephone_number": "304-225-6290",
            "fax_number": "304-225-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 GREENBAG ROAD",
            "address_2": "SUITE F6",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "26501",
            "telephone_number": "304-225-6290",
            "fax_number": "304-225-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER HOME MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "304-225-6290",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WV",
            "license": "CONTROLNUMBER72117",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WV",
            "license": "770649",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001704877",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN PROVIDER #",
            "identifier": "DME315",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001835",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407251100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101294177 0001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjackson@mountaineerhomemedical.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5000 Greenbag Road",
            "address_2": "Suite F6",
            "city": "Morgantown",
            "state": "WV",
            "country_code": "US",
            "postal_code": "26501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; 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.

Verify at the official NPI Registry.