Vladimer Bakhutashvili, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

25MA11938600 Issued in NJ

Practice address

101 Stadium Dr
Morgantown, WV 26506-7911

Phone

(304) 598-4850

Fax

(304) 598-4871

NPI assigned

Mar 21, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Endocrinology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kennedy Medical Group Practice, P.C.Group PAC ID 2860616877, 417 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Thomas Jefferson University Hospital Hospital, Philadelphia, PA, CCN 390174

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Kennedy Medical Group Practice, P.C.

  • Family Medicine Physician
  • Voorhees, NJ
  • NPI 1952726796

  Endocrinology, Diabetes & Metabolism

  Medicare reassignment Care Compare group NPD
• Kennedy Medical Group Practice P.C.

  • Family Medicine Physician
  • Turnersville, NJ
  • NPI 1881987337

  Endocrinology, Diabetes & Metabolism

  NPD
• Kennedy Medical Group Practice PC

  • Family Medicine Physician
  • Sewell, NJ
  • NPI 1952848905
  NPD
• Kennedy Medical Group Practice P.C.

  • Family Medicine Physician
  • West Deptford, NJ
  • NPI 1952615981
  NPD (past)

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

• Thomas Jefferson University Hospitals Inc

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1215916002
  Care Compare affiliation

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1851895080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 STADIUM DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265067911",
            "telephone_number": "304-598-4850",
            "fax_number": "304-598-4871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 STADIUM DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265067911",
            "telephone_number": "304-598-4850",
            "fax_number": "304-598-4871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Laurel Oak Rd",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080434453",
            "country_code": "US",
            "telephone_number": "844-542-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAKHUTASHVILI",
        "first_name": "VLADIMER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NJ",
            "license": "25MA11938600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaime Leigh Baker, MA
• Lucas Baker
• Samantha Baker
• Samantha Jo Baker
• Vicki V Baker, M.D.
• Lauren Bakos, DDS
• Lester H Bakos, DDS
• Nicole Bakos, PTA
• George K Bal, M.D.
• Bathmapriya Balakrishnan, M.D

• Endocrinology, Diabetes & Metabolism Physician in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Endocrinology, Diabetes & Metabolism Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.