Active NPI
Charles Dougherty, M.D.
- Pediatrics Physician
- Saint Louis, MO
National Provider Identifier
1134100100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- R6070
- Practice address
- 13303 Tesson Ferry Rd
Saint Louis, MO 63128-4062 - Phone
- (314) 842-5239
- Fax
- (314) 842-3835
- NPI assigned
- Nov 8, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | R6070 | MO | Primary |
Addresses
Primary practice location
13303 Tesson Ferry Rd
Saint Louis, MO 63128-4062
Mailing address
PO Box 23340
Saint Louis, MO 63156-3340
Phone (314) 842-5239
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40420 | Other | MO | GHP |
| 17699 | Other | MO | BCB |
| 1200163 | Other | MO | UHC |
| 40000261 | Other | MO | AETNA |
| 100732 | Other | MO | HEALTHLINK |
| 5724V34311 | Other | MO | HEALTHCARE USA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R6070 | MO | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348185600000",
"number": "1134100100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 23340",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631563340",
"telephone_number": "314-842-5239",
"fax_number": "314-842-3835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13303 TESSON FERRY RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631284062",
"telephone_number": "314-842-5239",
"fax_number": "314-842-3835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "CHARLES",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-08",
"last_updated": "2012-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "R6070",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "40420",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCB",
"identifier": "17699",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "1200163",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "40000261",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "100732",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHCARE USA",
"identifier": "5724V34311",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
- Double D Investment Group, LLC (City Home Care Phase II)
- Emily Drazinski Doucette, M.D.
- Joseph W. Doud, AA-C
- Dougherty Emergency Physicians LLC
- Rebecca Dougherty Froelke, MSW, LCSW
- Cynthia Dougherty
- Kristen Dougherty
- Matthew Dougherty, MD
- Stefanie Brooke Dougherty, D.M.D., M.S.D.
- Thomas M Dougherty, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.