Carl Edwin Ducharme, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

S6824 Issued in TX

Practice address

900 E Southlake Blvd Ste 200
Southlake, TX 76092-6376

Phone

(817) 310-6050

Fax

(817) 310-6051

NPI assigned

Jun 16, 2010

Last updated

Dec 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2021 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Destination Health

  • Adult Medicine Physician
  • Southlake, TX
  • NPI 1346646528
  NPD (past)

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670716800000",
    "number": "1154642999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 E SOUTHLAKE BLVD STE 200",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926376",
            "telephone_number": "817-310-6050",
            "fax_number": "817-310-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E SOUTHLAKE BLVD STE 200",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926376",
            "telephone_number": "817-310-6050",
            "fax_number": "817-310-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCHARME",
        "first_name": "CARL",
        "middle_name": "EDWIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-16",
        "last_updated": "2022-12-11",
        "certification_date": "2022-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S6824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Pulianda & Associates (Pulianda & Brock Psychology Associates)
• Dra Health Services of Texas
• Joseph Dracobly, PH.D., BCBA-D, LBA
• Casey Leigh Drinnen, LPC
• DSL Tenant II LLC (Discovery Village at Southlake)
• Tequell Duff
• Rochelle R Duke-Rutledge, LPC-A
• Nicole Lynn Dunagan, M.A., CCC-SLP
• Heather Dunklin
• Donald Dunlap Jr., D.O.

• Internal Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.