NPIMap

Organization Active NPI

Charleston Cardiology Group PLLC

  • Cardiovascular Disease Physician
  • Charleston, WV
National Provider Identifier
1770558165
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CHARLESTON CARDIOLOGY GROUP PLLC
Practice address
3100 Maccorkle Ave
Suite 709
Charleston, WV 25304-1223
Phone
(304) 342-1184
Fax
(304) 343-8487
NPI assigned
Feb 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Donald R Lilly, MD
Title
Chairman Board of Directors
Phone
(304) 342-1184

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

3100 Maccorkle Ave
Suite 709
Charleston, WV 25304-1223

Mailing address

3100 Maccorkle Ave
Suite 709
Charleston, WV 25304-1223
Phone (304) 342-1184

Other identifiers 1

IdentifierTypeStateIssuer
3810004453MedicaidWV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770558165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE",
            "address_2": "SUITE 709",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041223",
            "telephone_number": "304-342-1184",
            "fax_number": "304-343-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE",
            "address_2": "SUITE 709",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041223",
            "telephone_number": "304-342-1184",
            "fax_number": "304-343-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON CARDIOLOGY GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LILLY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHAIRMAN BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "304-342-1184",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004453",
            "state": "WV"
        }
    ],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.