Individual provider Active NPI

Charlie Robert Vachris, L.I.S.W.

  • Clinical Social Worker
  • Columbus, OH
National Provider Identifier
1205854007
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I7107 Issued in OH
Practice address
1570 Fishinger Rd
Columbus, OH 43221-2114
Phone
(614) 823-7279
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I7107 OH Primary

Addresses

Primary practice location

1570 Fishinger Rd
Columbus, OH 43221-2114

Mailing address

PO Box 1526
Delaware, OH 43015-8526
Phone (740) 362-9226

Other identifiers 3

IdentifierTypeStateIssuer
246652OtherOHCOMPSYCH
203700OtherOHVALUE OPTIONS
000000113308OtherOHANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070223000020 OH Practitioner - Clinical Social Worker 1658473517 Practice locations: Columbus, OH

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1570 Fishinger Rd
Columbus, OH 43221-2114
Phone (614) 823-7279

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I7107OHMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205854007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1526",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430158526",
            "telephone_number": "740-362-9226",
            "fax_number": "740-362-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 FISHINGER RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432212114",
            "telephone_number": "614-823-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACHRIS",
        "first_name": "CHARLIE",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "L.I.S.W.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I7107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "246652",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "203700",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000113308",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.