Charles C Mauldin Jr., M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

MDR6J28 Issued in MO

Practice address

1308 N Glenstone Ave
Springfield, MO 65802-2130

Phone

(417) 864-4100

Fax

(417) 863-8697

NPI assigned

Aug 24, 2005

Last updated

Sep 27, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Springfield Physical Medicine and Rehabilitation, Inc

  • Health Service Clinic/Center
  • Springfield, MO
  • NPI 1225021231
  Authorized official Same address or phone

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190851200000",
    "number": "1194718270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 S GLENHAVEN AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047800",
            "telephone_number": "417-881-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 N GLENSTONE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658022130",
            "telephone_number": "417-864-4100",
            "fax_number": "417-863-8697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAULDIN",
        "first_name": "CHARLES",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2007-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "MDR6J28",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202697900",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "43151887165802A005",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2079425",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US POSTAL SERVICE",
            "identifier": "ACS#140740000",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "19288",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D1025378",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9378408",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy G. Mattax, PH.D.
• Carol A Matthews, NP
• Jennifer Louise Mattox
• Curtis A Mattson, PSYD
• Amy Nicole Matz, NP-C
• Naomi Alynn Maunu, PT, DPT
• Charles A Maurer, DC
• Matthew Charles Maurer, D.C.
• Maxim Healthcare Services, Inc.
• Maxim Healthcare Services, Inc.

• Physical Medicine & Rehabilitation Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Physical Medicine & Rehabilitation Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.