Jerome D. Massenburg, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

14621 Issued in WV

Practice address

2121 Lake Ave
Fort Wayne, IN 46805-5100

Phone

(260) 426-5431

Fax

(260) 460-1481

NPI assigned

Aug 15, 2006

Last updated

Jun 20, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Charleston Psychiatric Group, Inc.

  • Psychiatry Physician
  • Charleston, WV
  • NPI 1134142144
  NPD (past)
• Highland Behavioral Health Services Inc

  dba Process Strategies

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charleston, WV
  • NPI 1740291897
  NPD (past)
• Highland Behavioral Health Services, Inc

  dba Advance Healthcare@UC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charleston, WV
  • NPI 1760896740
  NPD (past)
• Valley Comprehensive Community Mental Health Center

  dba Valley HealthCare System

  • Community/Behavioral Health Agency
  • Morgantown, WV
  • NPI 1154740660
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1811900277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 QUARRIER ST",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253010006",
            "telephone_number": "304-344-0349",
            "fax_number": "304-344-0384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5431",
            "fax_number": "260-460-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSENBURG",
        "first_name": "JEROME",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": "14621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Mason, MD
• Thomas Michael Mason
• Autumn Masoner, RBT
• Massage Therapy Clinc
• Massage Works Therapy Center LLC
• Kara Massey
• Deanna L. Massie, CNS
• Kathy Massonne, LCSW
• Mastbaum Endocrinology
• Leonard I Mastbaum, MD

• Psychiatry Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; 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.