Individual provider Active NPI

Maple T. Landvoigt, MD

  • Pediatric Pulmonology Physician
  • Lewisburg, WV
National Provider Identifier
1982833760
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
22154 Issued in WV
Practice address
1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone
(304) 645-3220
Fax
(844) 479-4545
NPI assigned
Jul 14, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 22154 WV
Internal Medicine Physician 207R00000X 22154 WV
Pediatric Pulmonology Physician 2080P0214X 22154 WV Primary

Addresses

Primary practice location

1464 Jefferson St N
Lewisburg, WV 24901-1380

Mailing address

1464 Jefferson St N
Lewisburg, WV 24901-1380
Phone (304) 645-3220

Other identifiers 1

IdentifierTypeStateIssuer
3810015441MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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

Enrollment IDStateProvider typePAC IDDetails
I20091014000822 WV Practitioner - Pediatric MedicinePractitioner - Internal Medicine 2466598883 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia School of Osteopathic Medicine Clinic Inc D/B/a Robert C. Byrd Clinic Pediatrics CurrentSince Jul 1, 2016 Accepting new patients

Locations

1464 Jefferson St N
Lewisburg, WV 24901
Phone (304) 647-5577

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1982833760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDVOIGT",
        "first_name": "MAPLE",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-14",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "22154",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "22154",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "WV",
            "license": "22154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810015441",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisburg, WV

Sources for this page

Verify at the official NPI Registry.