NPIMap

Individual provider Active NPI

Charles E Nicholson III, MD

  • Internal Medicine Physician
  • Langhorne, PA
National Provider Identifier
1215433867
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD475093 Issued in PA
Practice address
240 Middletown Blvd Ste 203
Langhorne, PA 19047-1832
Phone
(215) 750-2300
NPI assigned
Apr 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD475093 PA Primary

Addresses

Primary practice location

240 Middletown Blvd Ste 203
Langhorne, PA 19047-1832

Mailing address

61 Sequoia Dr
Newtown, PA 18940-9243
Phone (704) 360-0299

Other practice location 1

1201 Langhorne Newtown Rd
Langhorne, PA 19047-1201
Phone (215) 710-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803000978 PA Practitioner - Internal Medicine 3870832215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1201 Langhorne Newtown Rd
Langhorne, PA 19047-1201

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

240 Middletown Blvd
Langhorne, PA 19047-1832

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Aug 22, 2021 Accepting new patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Aug 22, 2021 Accepting new patients
Trinity Health Mid-Atlantic Medical Group Past Accepting new patients
Trinity Health Mid-Atlantic Medical Group Internal Medicine Past Accepting new patients

Locations

240 Middletown Blvd
Ste 203
Langhorne, PA 19047
Phone (215) 750-2300

41 University Dr
Ste 300
Newtown, PA 18940
Phone (215) 710-7037

1201 Langhorne Newtown Rd
Penndel, PA 19047
Phone (215) 710-2100

Interoperability endpoints

  • Direct secure messaging: cnicholson85150@direct.trinity-health.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1215433867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 SEQUOIA DR",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189409243",
            "telephone_number": "704-360-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MIDDLETOWN BLVD STE 203",
            "city": "LANGHORNE",
            "state": "PA",
            "postal_code": "190471832",
            "telephone_number": "215-750-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Langhorne Newtown Rd",
            "address_purpose": "LOCATION",
            "city": "Langhorne",
            "state": "PA",
            "postal_code": "190471201",
            "country_code": "US",
            "telephone_number": "215-710-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD475093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Langhorne, PA

Sources for this page

Verify at the official NPI Registry.