NPIMap

Individual provider Active NPI

Tamejiro Takubo Jr., D.O.

  • Critical Care Medicine (Internal Medicine) Physician
  • South Charleston, WV
National Provider Identifier
1841218872
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
1828 Issued in WV
Practice address
4619 Kanawha Ave SW
South Charleston, WV 25309-1319
Phone
(304) 400-4545
Fax
(304) 400-4546
NPI assigned
Jul 17, 2006
Last updated
Jan 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 1828 WV Primary
Pulmonary Disease Physician 207RP1001X 1828 WV

Addresses

Primary practice location

4619 Kanawha Ave SW
South Charleston, WV 25309-1319

Mailing address

4619 Kanawha Ave SW
South Charleston, WV 25309-1319
Phone (304) 400-4545

Other practice location 1

3200 MacCorkle Ave SE
Charleston, WV 25304-1227
Phone (304) 388-5432

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
I20040518000252 WV Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 5991795197 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
West Virginia School of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

122 12TH St
Princeton, WV 24740-2312
Phone (304) 487-7936

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

4619 Kanawha Ave SW
South Charleston, WV 25309-1319
Phone (304) 400-4545

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1685TNMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Development Co CurrentSince Feb 20, 2021 Accepting new patients
Princeton Community Hospital Assn Inc. CurrentSince Jun 2, 2024 Accepting new patients
Pulmonary Associates of Char LLC Pulmonary Disease CurrentSince Aug 1, 2007 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Dec 31, 2019 Accepting new patients
Hospital Development Co CurrentSince Feb 20, 2021 Accepting new patients
Princeton Community Hospital Assn., Inc CurrentSince Jun 2, 2024 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Dec 31, 2019 Accepting new patients
Hospital Development Co Current Accepting new patients
Hospital Development Co Current Accepting new patients
THS Physician Partners Inc Pulmonary Disease CurrentSince Jun 1, 2023 Accepting new patients
Tennessee Critical Care Services, Inc Critical Care Medicine Past Accepting new patients
National Emergency Services West Virginia Inc Past Accepting new patients

Locations

L3539
Columbus, OH 43260
Phone (304) 414-4800

401 E Vermillion St
Athens, WV 24712
Phone (304) 384-7325

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

3200 Maccorkle Ave SE
#C
Charleston, WV 25304
Phone (304) 347-1336

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

401 6th Ave
Montgomery, WV 25136
Phone (304) 442-5151

122 12th St
Princeton, WV 24740
Phone (304) 487-7061

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

4607 Maccorkle Ave SW
Ste 401
South Charleston, WV 25309
Phone (304) 414-2120

4619 Kanawha Ave SW
South Charleston, WV 25309
Phone (304) 400-4545

200 Hospital Dr
Spencer, WV 25276
Phone (304) 927-4444

Interoperability endpoints

  • Direct secure messaging: ttakubo@pac.gwaydirect.com
  • Direct secure messaging: ttakubo357559@direct.wvuhsdirect.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Princeton Community Hospital Association IncBluefield, WV, CCN 510046 Hospital Corporate Director Jan 1, 2023
Princeton Community Hospital Assn. Inc.Bluefield, WV, CCN 51S046 Hospital Corporate Director Jan 1, 2023
Athens Medical CenterAthens, WV, CCN 513995 Rural health clinic Corporate Officer Jan 1, 2023
Princeton Community Hospital Assn. Inc.Bluefield, VA, CCN 493464 Rural health clinic Corporate Director Jan 1, 2023

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

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 12

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1841218872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4619 KANAWHA AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091319",
            "telephone_number": "304-400-4545",
            "fax_number": "304-400-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4619 KANAWHA AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091319",
            "telephone_number": "304-400-4545",
            "fax_number": "304-400-4546"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 MacCorkle Ave SE",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041227",
            "country_code": "US",
            "telephone_number": "304-388-5432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAKUBO",
        "first_name": "TAMEJIRO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WV",
            "license": "1828",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WV",
            "license": "1828",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.