Active NPI
United Hospital Center, Inc.
- Family Medicine Physician
- Bridgeport, WV
National Provider Identifier
1992155097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- UNITED HOSPITAL CENTER, INC.
- Practice address
- 120 Medical Park Dr
Ste 300
Bridgeport, WV 26330-9012 - Phone
- (304) 624-7200
- Fax
- (304) 423-5302
- NPI assigned
- Jun 20, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael Tillman
- Title
- Ceo
- Phone
- (681) 342-1600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
120 Medical Park Dr
Ste 300
Bridgeport, WV 26330-9012
Mailing address
527 Medical Park Dr
Ste 400
Bridgeport, WV 26330-9008
Phone (681) 342-3500
Other names 1
- Bridgeport Family Healthcare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031212000802 | WV | Part B Supplier - Clinic/Group Practice | 8123936010 |
Receives reassigned benefits from 473 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: White Hall, WV; Weston, WV; Summersville, WV; Nutter Fort, WV; Grafton, WV; Glenville, WV; Fairmont, WV; Elkins, WV… |
Other NPIs on the same Medicare enrollment 27
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Orthopaedic Surgery Physician
- Bridgeport, WV
- NPI 1720133473
O20031212000802
-
- Pain Medicine (Anesthesiology) Physician
- Bridgeport, WV
- NPI 1023196391
O20031212000802
-
- Neurological Surgery Physician
- Bridgeport, WV
- NPI 1306929476
O20031212000802
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2122395 | Upc-Bridgeport Family Healthcare | Certificate of waiver | Nov 28, 2026 |
| 51D2333099 | Wvu Medicine MMRC - United Hospital Center | Certificate of waiver | Oct 29, 2027 |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466380800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1466380800000",
"number": "1992155097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "527 MEDICAL PARK DR",
"address_2": "STE 400",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263309008",
"telephone_number": "681-342-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 MEDICAL PARK DR",
"address_2": "STE 300",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263309012",
"telephone_number": "304-624-7200",
"fax_number": "304-423-5302"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNITED HOSPITAL CENTER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2016-06-20",
"last_updated": "2016-06-20",
"status": "A",
"authorized_official_last_name": "TILLMAN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "681-342-1600"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Bridgeport Family Healthcare",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Bridgeport, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.