NPIMap

Organization Active NPI

Charlestown Primary Care LLC

  • Family Medicine Physician
  • Charlestown, IN
National Provider Identifier
1114108164
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01061465A Issued in IN
Legal business name
CHARLESTOWN PRIMARY CARE LLC
Practice address
3901 County Road 160
Charlestown, IN 47111-9181
Phone
(812) 406-6897
Fax
(812) 256-3577
NPI assigned
Nov 19, 2007
Last updated
Apr 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Authorized official

Name
Dr. Willam E Hoke, MD
Title
Member
Phone
(812) 256-1106

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71003560A IN
Family Nurse Practitioner 363LF0000X 71002399A IN
Family Medicine Physician 207Q00000X 01061465A IN Primary

Addresses

Primary practice location

3901 County Road 160
Charlestown, IN 47111-9181

Mailing address

3901 County Road 160
Charlestown, IN 47111-9181
Phone (812) 406-6897

Other identifiers 2

IdentifierTypeStateIssuer
000000549269OtherINANTHEM GROUP NUMBER
20089454AMedicaidIN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555545600000",
    "number": "1114108164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 COUNTY ROAD 160",
            "city": "CHARLESTOWN",
            "state": "IN",
            "postal_code": "471119181",
            "telephone_number": "812-406-6897",
            "fax_number": "812-256-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 COUNTY ROAD 160",
            "city": "CHARLESTOWN",
            "state": "IN",
            "postal_code": "471119181",
            "telephone_number": "812-406-6897",
            "fax_number": "812-256-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTOWN PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2019-04-18",
        "status": "A",
        "authorized_official_last_name": "HOKE",
        "authorized_official_first_name": "WILLAM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "812-256-1106",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71003560A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002399A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01061465A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP NUMBER",
            "identifier": "000000549269",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20089454A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlestown, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.