NPIMap

Individual provider Active NPI

Paul William Kloostra, MD, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Charleston, WV
National Provider Identifier
1952503104
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
26313 Issued in WV
Practice address
830 Pennsylvania Ave
Suite 302
Charleston, WV 25302-3302
Phone
(304) 388-2950
Fax
(304) 388-2951
NPI assigned
Jun 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 26313 WV Primary

Addresses

Primary practice location

830 Pennsylvania Ave
Suite 302
Charleston, WV 25302-3302

Mailing address

830 Pennsylvania Ave 302
Charleston, WV 25302-3390
Phone (304) 388-2950

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
I20150117000142 WV Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 1355575234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
University of Michigan School of Dentistry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

800 Pennsylvania Ave
Charleston, WV 25302-3351
Phone (304) 388-5432

830 Pennsylvania Ave
Charleston, WV 25302-3390

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

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

3100 Maccorkle Ave SE
Ste 203
Charleston, WV 25304
Phone (304) 345-8820

830 Pennsylvania Ave
Ste 302
Charleston, WV 25302
Phone (304) 388-2950

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

Organizations & group practices 4

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.

Hospital & facility affiliations 11

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1952503104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 PENNSYLVANIA AVE 302",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253023390",
            "telephone_number": "304-388-2950",
            "fax_number": "304-388-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 PENNSYLVANIA AVE",
            "address_2": "SUITE 302",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253023302",
            "telephone_number": "304-388-2950",
            "fax_number": "304-388-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOOSTRA",
        "first_name": "PAUL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "26313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.