Mountain State Orthopedics and Sports Medicine

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

Legal business name

MOUNTAIN STATE ORTHOPEDICS AND SPORTS MEDICINE

Practice address

4089W Webster Rd
Summersville, WV 26651-9682

Phone

(304) 900-2589

Fax

(800) 397-1586

NPI assigned

Jan 24, 2022

Last updated

Mar 13, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. William R Carson, M.D.NPI 1851445225

Title

President

Phone

(304) 900-2589

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 2

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.

• William R Carson, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Summersville, WV
  • NPI 1851445225

  Single Specialty

  Medicare reassignment NPD Authorized official
• Heather Dawn O'Dell, FNP

  • Family Nurse Practitioner
  • Oak Hill, WV
  • NPI 1992078380
  NPD

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

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1831841675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4089 WEBSTER RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266517200",
            "telephone_number": "304-900-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4089W WEBSTER RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519682",
            "telephone_number": "304-900-2589",
            "fax_number": "800-397-1586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE ORTHOPEDICS AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-900-2589",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley Thomas Morris, MD
• Mountain Lake Pharmacy Inc (Mountain Lake Pharmacy)
• Mountain Light Mental Health LLC
• Mountain Ridge Dialysis LLC
• Mountain State Orthopedics & Sports Medicine
• Mountain State Urgent Care
• Mountain Transit Authority
• Mountaineer Physical Therapy & Sports Medicine
• Lisa Dawn Mowery
• Christina Marie Moyers, MS, RD, LD

• Sports Medicine (Orthopaedic Surgery) Physician in Summersville, WV
• Providers in Summersville, WV by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.