Charles McCarley Elliott, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

05601 Issued in MS

Practice address

1009 City Ave N
Suite a
Ripley, MS 38663-1414

Phone

(662) 837-1404

Fax

(662) 837-3760

NPI assigned

Jan 26, 2006

Last updated

Feb 21, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/tippah-ba3c06de

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.

• Primary Care Clinic of Ripley PA

  • Family Medicine Physician
  • New Albany, MS
  • NPI 1356312623
  Medicare reassignment NPD
• The Women's Clinic of New Albany, P.C.

  • Obstetrics & Gynecology Physician
  • New Albany, MS
  • NPI 1417093220
  NPD (past)
• Tippah County Hospital

  dba Tippah Care Walnut

  • Family Medicine Physician
  • Walnut, MS
  • NPI 1124823521
  NPD (past)

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329782400000",
    "number": "1063482404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 CITY AVE N",
            "address_2": "SUITE A",
            "city": "RIPLEY",
            "state": "MS",
            "postal_code": "386631414",
            "telephone_number": "662-837-1404",
            "fax_number": "662-837-3760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 CITY AVE N",
            "address_2": "SUITE A",
            "city": "RIPLEY",
            "state": "MS",
            "postal_code": "386631414",
            "telephone_number": "662-837-1404",
            "fax_number": "662-837-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "CHARLES",
        "middle_name": "MCCARLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2012-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "05601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0013009",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald P. Roten, DDS, P.a.
• Lori S Duke, DNP, FNP-C
• Karen Dulaney, PCMHT
• Kasha Edgeston, M.A.
• Jody Lynn Edwards, MSW, LSW
• Reeca L Elliott, RPH
• Teressa Ellzey, BSW
• Family Care Clinic of Ripley
• Family Foot Care Clinic Inc
• Family Foot Care Clinic Inc

• Family Medicine Physician in Ripley, MS
• Providers in Ripley, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.