Charlotte L Lofgren, M.D.
Individual provider Active NPI Pediatrics Physician · Wolcott, NY
NPI 1154529436 · NPPES record last updated Jun 4, 2020
Key facts
- NPI
- 1154529436
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 305192 (NY)
- Practice address
- 6254 Lawville Rd
Wolcott, NY 14590-9792 - Phone
- (315) 594-9444
- Fax
- (315) 594-9276
- NPI assigned
- Jul 6, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101221001161 | MI | Practitioner - Pediatric Medicine | 6507054269 | Reassigns benefits to 4 organizations |
| I20200615002932 | NY | Practitioner - Pediatric Medicine | 6507054269 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301090376 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeland Community Hospital Watervliet | Current | Accepting new patients | |
| Lakeland Medical Practices | Current |
Accepting new patients | |
| Rochester General Hospital | Current |
Accepting new patients | |
| Lakeland Community Hospital Watervliet | Current |
Accepting new patients | |
| Intercare Community Health Network | Current |
Accepting new patients | |
| Rochester General Hospital | Pediatrics | Current | Accepting new patients |
| Lakeland Community Hospital Watervliet | Current |
Accepting new patients | |
| Rochester General Hospital | Pediatrics | Current |
Accepting new patients |
| Lakeland Medical Practices | Current |
Accepting new patients | |
| Lakeland Community Hospital Watervliet | Current |
Accepting new patients | |
| Intercare Community Health Network | Current |
Accepting new patients | |
| Intercare Community Health Network | Current | Accepting new patients | |
| Rochester General Hospital | Past | Accepting new patients | |
| Newark Wayne Community Hospital | Past | Accepting new patients |
Locations
50 Industrial Park Rd
Bangor, MI 49013
Phone (269) 427-7937
800 M 139
Benton Harbor, MI 49022
Phone (269) 927-5400
2002 S 11th St
Niles, MI 49120
Phone (269) 687-0200
3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990
400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111
1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122
100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553
6254 Lawville Rd
Wolcott, NY 14590
Phone (315) 594-9444
Interoperability endpoints
- clofgren941@lakeland.midirect.net
- https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/
- clofgren302265@direct.rochesterregional.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301090376 | MI | |
| Pediatrics Physician | 208000000X | 305192 | NY | Yes |
Addresses
Primary practice location
6254 Lawville Rd
Wolcott, NY 14590-9792
Mailing address
100 Kings Hwy S
Rochester, NY 14617-5504
Phone (315) 594-9444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154529436 | Medicaid | MI |
Other providers in Wolcott, NY
- Lakeshore Volunteer Ambulance Inc
- Casen Lange
- Joella Lange
- Susan T. Lapp
- Chantel Melanie Upson Lockwood
- Debra Mastrangelo
- John Myers
- Thambirajah Nagendra
- North Rose-Wolcott CSD
- Onondaga Physical Therapy
All providers in Wolcott, NY · Pediatrics Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.