NPIMap

Individual provider Active NPI

James William Endicott, MD

  • Family Medicine Physician
  • Kermit, WV
National Provider Identifier
1790782753
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14258 Issued in WV
Practice address
108 Mingo St
Kermit, WV 25674-0430
Phone
(304) 393-4303
Fax
(304) 393-3254
NPI assigned
Jul 6, 2005
Last updated
Feb 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14258 WV Primary

Addresses

Primary practice location

108 Mingo St
Kermit, WV 25674-0430

Mailing address

PO Box 430
Kermit, WV 25674-0430
Phone (304) 393-4303

Other identifiers 1

IdentifierTypeStateIssuer
0051733000MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address james.endicott@marshall.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100223000400 WV Practitioner - Family Practice 0143364596 Reassigns benefits to 1 organization
Practice locations: Kermit, WV

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
JC Edwards School of Medicine, Marshall University, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

108 Mingo St
Kermit, WV 25674-0430
Phone (304) 393-4303

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14258WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians & Surgeons, Inc. CurrentSince Jan 1, 2023 Accepting new patients
University Physicians & Surgeons, Inc Family Medicine CurrentSince Jan 1, 2023 Accepting new patients
University Pediatric Associates, Inc. Past Accepting new patients

Locations

1448 10th Ave
Ste 304
Huntington, WV 25701
Phone (304) 691-6381

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

Interoperability endpoints

  • Direct secure messaging: james.endicott.1@10573.direct.athenahealth.com
  • Direct secure messaging: james.endicott@marshall.cernerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1790782753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "KERMIT",
            "state": "WV",
            "postal_code": "256740430",
            "telephone_number": "304-393-4303",
            "fax_number": "304-393-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MINGO ST",
            "city": "KERMIT",
            "state": "WV",
            "postal_code": "256740430",
            "telephone_number": "304-393-4303",
            "fax_number": "304-393-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDICOTT",
        "first_name": "JAMES",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "14258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051733000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "james.endicott@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "108 Mingo St",
            "city": "Kermit",
            "state": "WV",
            "country_code": "US",
            "postal_code": "256740430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kermit, WV

Sources for this page

Verify at the official NPI Registry.