NPIMap

Individual provider Active NPI

Charles W Anderegg, PAC

  • Surgical Physician Assistant
  • Shelton, WA
National Provider Identifier
1124056437
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA10003420 Issued in WA
Practice address
1701 N 13TH St Ste a
Shelton, WA 98584-2077
Phone
(360) 426-2653
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA052594 PA
Surgical Physician Assistant 363AS0400X PA10003420 WA Primary

Addresses

Primary practice location

1701 N 13TH St Ste a
Shelton, WA 98584-2077

Mailing address

PO Box 1668
Shelton, WA 98584-5001
Phone (360) 427-9549

Other identifiers 1

IdentifierTypeStateIssuer
8521973MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060309000091 WA Practitioner - Physician Assistant 7719994284 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olympia Orthopaedic Associates PLLC 87 clinicians

Practice addresses (Care Compare)

615 Lilly Rd NE
Olympia, WA 98506-5117
Phone (360) 491-4211

Hospital & facility affiliations

  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336
  • Capital Medical Center Hospital, Olympia, WA, CCN 500139

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA10003420WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District No 1 of Mason County CurrentSince Jan 23, 2026 Accepting new patients
Dean S Ricketts MD Inc PS Past Accepting new patients

Locations

1701 N 13th St
Ste A
Shelton, WA 98584
Phone (360) 426-2653

1710 N 13th Loop Rd
Shelton, WA 98584
Phone (360) 426-4142

1701 N 13th St
Shelton, WA 98584
Phone (360) 426-2653

901 Mountain View Dr
Shelton, WA 98584
Phone (360) 426-1611

Interoperability endpoints

  • Direct secure messaging: charles.anderegg.1@5512.direct.athenahealth.com

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1124056437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1668",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985845001",
            "telephone_number": "360-427-9549",
            "fax_number": "360-427-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N 13TH ST STE A",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842077",
            "telephone_number": "360-426-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDEREGG",
        "first_name": "CHARLES",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA052594",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10003420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8521973",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

Verify at the official NPI Registry.