NPIMap

Organization Active NPI

United Hospital Center

  • Rheumatology Physician
  • Bridgeport, WV
National Provider Identifier
1780767772
Registry record updated Nov 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
UNITED HOSPITAL CENTER
Practice address
710 Genesis Blvd
Bridgeport, WV 26330-9668
Phone
(681) 342-3490
Fax
(681) 342-3491
NPI assigned
Oct 23, 2006
Last updated
Nov 1, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
UNITED HOSPITAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 2017

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

Authorized official

Name
Michael Tillman
Title
Ceo
Phone
(681) 342-1000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X WV107 WV
Rheumatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RR0500X Primary

Addresses

Primary practice location

710 Genesis Blvd
Bridgeport, WV 26330-9668

Mailing address

527 Medical Park Dr Ste 400
Bridgeport, WV 26330-9010
Phone (681) 342-3500

Other identifiers 2

IdentifierTypeStateIssuer
001709473OtherWVBLUE CROSS PAY TO NUMBER
3810008622MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000802 WV Part B Supplier - Clinic/Group Practice 8123936010 Receives reassigned benefits from 473 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: White Hall, WV; Weston, WV; Summersville, WV; Nutter Fort, WV; Grafton, WV; Glenville, WV; Fairmont, WV; Elkins, WV…

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

National Provider Directory

National Provider Directory
Part of
Saad Massallati MD

Locations

120 Medical Park Dr
Ste 300
Bridgeport, WV 26330
Phone (304) 624-7200

135 Professional Pl
Bridgeport, WV 26330
Phone (681) 342-3595

16 Sterling Dr
Ste 202
Bridgeport, WV 26330
Phone (304) 566-7760

227 Medical Park Dr
Ste 101
Bridgeport, WV 26330
Phone (681) 342-3490

227 Medical Park Dr
Ste 103
Bridgeport, WV 26330
Phone (681) 342-3561

527 Medical Park Dr
Bridgeport, WV 26330
Phone (681) 342-3600

527 Medical Park Dr
Ste 102
Bridgeport, WV 26330
Phone (304) 933-3816

527 Medical Park Dr
Ste 107
Bridgeport, WV 26330
Phone (304) 933-3843

527 Medical Park Dr
Ste 201
Bridgeport, WV 26330
Phone (304) 933-3825

527 Medical Park Dr
Ste 202A
Bridgeport, WV 26330

527 Medical Park Dr
Ste 302
Bridgeport, WV 26330
Phone (304) 933-3928

527 Medical Park Dr
Ste 401
Bridgeport, WV 26330
Phone (304) 624-2121

300 Davisson Run Rd
Ste 101A
Clarksburg, WV 26301

300 Davisson Run Rd
Ste 103
Clarksburg, WV 26301
Phone (304) 623-0496

1013 N Randolph Ave
Elkins, WV 26241
Phone (681) 342-3000

100 Stoney Hill Rd
Fairmont, WV 26554
Phone (304) 285-5400

1325 Locust Ave
Fl 1
Fairmont, WV 26554

1325 Locust Ave
Ste 15
Fairmont, WV 26554
Phone (304) 366-0111

Practitioners & affiliated clinicians

Practitioners 179

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 179

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1780767772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR STE 400",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309010",
            "telephone_number": "681-342-3500",
            "fax_number": "681-342-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 GENESIS BLVD",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309668",
            "telephone_number": "681-342-3490",
            "fax_number": "681-342-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED HOSPITAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNITED HOSPITAL CENTER, INC",
        "enumeration_date": "2006-10-23",
        "last_updated": "2017-11-01",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "681-342-1000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "WV107",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PAY TO NUMBER",
            "identifier": "001709473",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810008622",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.