Charles John Gutierrez, M.D.

Key facts

NPI

1104807627

Entity type

Individual (NPI type 1)

Primary specialty

Surgery Physician 208600000X

License

K9794 (TX)

Practice address

350 Pine St
Suite 1415
Beaumont, TX 77701-2441

Phone

(409) 924-8600

Fax

(409) 924-8607

NPI assigned

Nov 10, 2005

Sex

Male

Sole proprietor

Yes

Organizations & group practices 6

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.

• East Texas Surgical Associates, PA Surgery Physician · Beaumont, TX · NPI 1497892152
  Medicare reassignment Care Compare group NPD Authorized official SURGERY · TX
• Robert Marriott Medical Corp Surgery Physician · El Segundo, CA · NPI 1083883938
  Medicare reassignment NM · TX
• Nirp Beaumont, PLLC Interventional Cardiology Physician · Beaumont, TX · NPI 1609392430
  NPD VASCULAR SURGERY
• Robert Marriott Medical Corp Surgery Physician · San Antonio, TX · NPI 1356892962
  NPD SURGERY
• Charles J. Rodman, MD PA Vascular Surgery Physician · Beaumont, TX · NPI 1215092689
  NPD (past) VASCULAR SURGERY
• Methodist Physician Practices, PLLC Surgery Physician · San Antonio, TX · NPI 1922252717
  NPD (past) SURGERY

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Altus Home Health, LLC Home Health Agency · Beaumont, TX · NPI 1679842298
  Care Compare affiliation Home health agency
• JCH Inc Home Health Agency · Beaumont, TX · NPI 1134128648
  Care Compare affiliation Home health agency

Medicare Care Compare profile

Specialty

Vascular Surgery

Education

University of Southern California Keck School of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Texas Surgical Associates, PA (5 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Vitalcaring Group Home health agency · Beaumont, TX · CCN 459471
• Harbor Home Health Home health agency · Beaumont, TX · CCN 679163

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in TX, NM

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.gutierrez@vascare.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/GFGDCA/Endpoint/GFGDCA
• FHIR API: https://api.platform.athenahealth.com/16700/brand/2/csg/1/fhir/r4

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 5, 2024.

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1104807627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 PINE ST",
            "address_2": "SUITE 1415",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777012441",
            "telephone_number": "409-924-8600",
            "fax_number": "409-924-8607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 PINE ST",
            "address_2": "SUITE 1415",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777012441",
            "telephone_number": "409-924-8600",
            "fax_number": "409-924-8607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1521 S Staples St Ste 510",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784043152",
            "country_code": "US",
            "telephone_number": "361-882-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "CHARLES",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "K9794",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "K9794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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