Charleen L. Ise, MD

Primary specialty

Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X

License

ME55512 Issued in FL

Practice address

1120 Pinellas Bayway
Ste 200
Tierra Verde, FL 33715-1505

Phone

(727) 867-5480

Fax

(727) 867-5470

NPI assigned

Aug 22, 2006

Last updated

Feb 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in FL

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nautilus Health Care Group LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Melbourne, FL
  • NPI 1912013558
  Medicare reassignment NPD
• Nautilus Health Care Group, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Kokomo, IN
  • NPI 1013234699
  NPD
• Advanced Wound Systems LLC

  • Durable Medical Equipment & Medical Supplies
  • St Petersburg, FL
  • NPI 1508054271
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1053427716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530968",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337470968",
            "telephone_number": "727-823-2188",
            "fax_number": "727-828-0723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 PINELLAS BAYWAY",
            "address_2": "STE 200",
            "city": "TIERRA VERDE",
            "state": "FL",
            "postal_code": "337151505",
            "telephone_number": "727-867-5480",
            "fax_number": "727-867-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISE",
        "first_name": "CHARLEEN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "FL",
            "license": "ME0055512",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "FL",
            "license": "ME55512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4045500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "0100444",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "267080",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00306082",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101276100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09781",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Gensch
• Gyenyame Medical Services
• Lisa Heller Chase, PT
• Julie Lynn Hiatt
• Innovative Healthy Aging, LLC
• Kori Kogan, PTA
• Vincent Patrick Kunz, MD
• Jan Marie Lundberg, D.C.
• Betty Menegia Chaviano
• Julio Enrique Montejo, D.O.

• Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Tierra Verde, FL
• Providers in Tierra Verde, FL by specialty
• Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.