Individual provider Active NPI

Charles T Dellinger, MD

  • Pediatrics Physician
  • Orange Park, FL
National Provider Identifier
1114990157
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME24210 Issued in FL
Practice address
2140 Smith St
Orange Park, FL 32073-5554
Phone
(904) 269-2140
Fax
(904) 264-3018
NPI assigned
Feb 9, 2006
Last updated
Jan 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME24210 FL Primary
Pediatric Adolescent Medicine Physician 2080A0000X ME24210 FL

Addresses

Primary practice location

2140 Smith St
Orange Park, FL 32073-5554

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-1032

Other practice location 1

6353 Argyle Forest Blvd Ste 4
Jacksonville, FL 32244-6602
Phone (904) 908-0200

Other practice location 2

1747 Baptist Clay Dr Ste 110
Fleming Island, FL 32003-8503
Phone (904) 520-6620

Other identifiers 1

IdentifierTypeStateIssuer
035767700MedicaidFL

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME24210FLMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Pediatrics PastSince Jan 29, 2023 Accepting new patients
Baptist Primary Care Inc Pediatrics Past Accepting new patients
Baptist Primary Care Inc Pediatrics Past Accepting new patients
Baptist Primary Care, Inc. Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cdellinger28498@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1114990157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 SMITH ST",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735554",
            "telephone_number": "904-269-2140",
            "fax_number": "904-264-3018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6353 Argyle Forest Blvd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322446602",
            "country_code": "US",
            "telephone_number": "904-908-0200",
            "fax_number": "904-908-3915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1747 Baptist Clay Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Fleming Island",
            "state": "FL",
            "postal_code": "320038503",
            "country_code": "US",
            "telephone_number": "904-520-6620",
            "fax_number": "904-215-2981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELLINGER",
        "first_name": "CHARLES",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME24210",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "FL",
            "license": "ME24210",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035767700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.