Active NPI
Charles D Washington, M.D.
- Emergency Medicine Physician
- Waupaca, WI
National Provider Identifier
1124058599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 53840-20
- Practice address
- 800 Riverside Dr
Waupaca, WI 54981-1943 - Phone
- (715) 258-1000
- NPI assigned
- Jul 3, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 036109776 | IL | |
| Emergency Medicine Physician | 207P00000X | 53840-20 | WI | Primary |
Addresses
Primary practice location
800 Riverside Dr
Waupaca, WI 54981-1943
Mailing address
3 Neenah Ctr
Neenah, WI 54956-3070
Phone (715) 258-1000
Other practice location 1
5666 East State St
Rockford, IL 61108-2472
Phone (815) 226-2000
Other practice location 2
620 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-6522
Other practice location 3
430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36109776 | Medicaid | IL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cwashington330506@direct-ehr-ssmhc.com | Direct | AGNESIAN HEALTHCARE INC |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other | AGNESIAN HEALTHCARE INC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100414000916 | WI | Practitioner - Emergency Medicine | 1153329073 | Reassigns benefits to 13 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Thedacare Regional Medical Center - Appleton, Inc
Practice addresses (Care Compare)
755 W Johnson St
Fond Du Lac, WI 54935-2089
Phone (920) 913-4400
Hospital & facility affiliations
- Thedacare Regional Medical Center - Appleton Inc
- Thedacare Medical Center - Berlin Inc
- Thedacare Medical Center - New London
- Thedacare Regional Med Ctr - Neenah
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036109776 | IL | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
Locations
1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101
225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313
430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200
755 W Johnson St
Fond du Lac, WI 54935
Phone (920) 731-4101
420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400
700 S Park St
Madison, WI 53715
Phone (608) 260-2900
3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229
1405 Mill St
New London, WI 54961
Phone (920) 531-2000
100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161
800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000
620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581
601 Grove Ave
Wild Rose, WI 54984
Phone (888) 287-4488
Interoperability endpoints
- cwashington330506@direct-ehr-ssmhc.com
Organizations & group practices 22
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.
-
- General Acute Care Hospital
- Appleton, WI
- NPI 1902832306
WI
-
- Emergency Medicine Physician
- Madison, WI
- NPI 1588646095
Emergency Medicine, WI
-
- Critical Access Hospital
- New London, WI
- NPI 1538127220
WI
-
- Emergency Medicine Physician
- Waupaca, WI
- NPI 1780782680
Emergency Medicine, WI
-
- Community/Retail Pharmacy
- Appleton, WI
- NPI 1417627704
-
- Rehabilitation Hospital Unit
- Appleton, WI
- NPI 1932085552
-
- Community/Retail Pharmacy
- Appleton, WI
- NPI 1457023772
Hospital & facility affiliations 17
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Wautoma, WI
- NPI 1992159289
Hospital
-
- Critical Access Hospital
- Clintonville, WI
- NPI 1144675745
Hospital
-
- Critical Access Hospital
- New London, WI
- NPI 1538127220
Hospital
-
- General Acute Care Hospital
- Appleton, WI
- NPI 1740920909
Hospital
-
- General Acute Care Hospital
- Appleton, WI
- NPI 1497119218
Hospital
-
- General Acute Care Hospital
- Appleton, WI
- NPI 1689038408
Hospital
-
- General Acute Care Hospital
- Appleton, WI
- NPI 1831773589
Hospital
-
- General Acute Care Hospital
- Appleton, WI
- NPI 1902832306
Hospital
-
- General Acute Care Hospital
- Fond Du Lac, WI
- NPI 1912721002
Hospital
-
- General Acute Care Hospital
- Oshkosh, WI
- NPI 1912880329
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747094400000",
"number": "1124058599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 NEENAH CTR",
"city": "NEENAH",
"state": "WI",
"postal_code": "549563070",
"telephone_number": "715-258-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 RIVERSIDE DR",
"city": "WAUPACA",
"state": "WI",
"postal_code": "549811943",
"telephone_number": "715-258-1000"
}
],
"practiceLocations": [
{
"address_1": "5666 East State St",
"address_purpose": "LOCATION",
"city": "Rockford",
"state": "IL",
"postal_code": "611082472",
"country_code": "US",
"telephone_number": "815-226-2000",
"fax_number": "815-381-7582",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "620 W Brown St",
"address_purpose": "LOCATION",
"city": "Waupun",
"state": "WI",
"postal_code": "539631702",
"country_code": "US",
"telephone_number": "920-324-6522",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "430 E Division St",
"address_purpose": "LOCATION",
"city": "Fond Du Lac",
"state": "WI",
"postal_code": "549354560",
"country_code": "US",
"telephone_number": "920-926-4600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WASHINGTON",
"first_name": "CHARLES",
"middle_name": "D",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2025-05-13",
"certification_date": "2025-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "IL",
"license": "036109776",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WI",
"license": "53840-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36109776",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cwashington330506@direct-ehr-ssmhc.com",
"affiliation": "Y",
"affiliationName": "AGNESIAN HEALTHCARE INC",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "cwashington330506@direct-ehr-ssmhc.com",
"address_1": "430 E Division St",
"city": "Fond Du Lac",
"state": "WI",
"country_code": "US",
"postal_code": "549354560",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "Y",
"affiliationName": "AGNESIAN HEALTHCARE INC",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIR API",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "430 E Division St",
"city": "Fond Du Lac",
"state": "WI",
"country_code": "US",
"postal_code": "549354560",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Waupaca, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.