NPIMap

Organization Active NPI

Jefferson Urgent Care, LLC

  • General Practice Physician
  • Charles Town, WV
National Provider Identifier
1992726236
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
JEFFERSON URGENT CARE, LLC
Practice address
84 Somerset Blvd
Charles Town, WV 25414-4827
Phone
(304) 728-8543
Fax
(304) 728-8644
NPI assigned
Jul 22, 2006
Last updated
Apr 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Authorized official

Name
Mr. Sean Patrick Rhoads, PACNPI 1548227499
Title
Owner
Phone
(304) 728-8543

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

84 Somerset Blvd
Charles Town, WV 25414-4827

Mailing address

84 Somerset Blvd
Charles Town, WV 25414-4827
Phone (304) 728-8543

Other names 1

  • Jefferson Urgent Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000141 WV Part B Supplier - Clinic/Group Practice 7315859535 Receives reassigned benefits from 10 practitioners
Practice locations: Charles Town, WV

National Provider Directory

National Provider Directory

Locations

84 Somerset Blvd
Charles Town, WV 25414
Phone (304) 728-8533

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1992726236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 SOMERSET BLVD",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254144827",
            "telephone_number": "304-728-8543",
            "fax_number": "304-728-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 SOMERSET BLVD",
            "city": "CHARLES TOWN",
            "state": "WV",
            "postal_code": "254144827",
            "telephone_number": "304-728-8543",
            "fax_number": "304-728-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON URGENT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "RHOADS",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-728-8543",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PAC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Urgent Care",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jefferson Urgent Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charles Town, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.