Active NPI
Charles Russell Hoffman Jr., M.D.
- Endocrinology, Diabetes & Metabolism Physician
- Louisville, KY
National Provider Identifier
1114911039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- 20669
- Practice address
- 4003 Kresge Way
Suite 400
Louisville, KY 40207-4652 - Phone
- (502) 895-4263
- Fax
- (502) 899-5488
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 20669 | KY | Primary |
Addresses
Primary practice location
4003 Kresge Way
Suite 400
Louisville, KY 40207-4652
Mailing address
PO Box 950248
Louisville, KY 40295-0248
Phone (502) 253-1035
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000047114 | Other | KY | ANTHEM BLUE PLANS |
| 1114911039 | Other | KY | RAILROAD MEDICARE |
| 6109684127212 | Other | KY | ANTHEM SENIOR ADVANTAGE |
| 64206691 | Medicaid | KY | |
| 50005575 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409097600000",
"number": "1114911039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 950248",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402950248",
"telephone_number": "502-253-1035",
"fax_number": "502-253-1037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4003 KRESGE WAY",
"address_2": "SUITE 400",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402074652",
"telephone_number": "502-895-4263",
"fax_number": "502-899-5488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOFFMAN",
"first_name": "CHARLES",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2014-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "KY",
"license": "20669",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE PLANS",
"identifier": "000000047114",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "1114911039",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM SENIOR ADVANTAGE",
"identifier": "6109684127212",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64206691",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "50005575",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.