Charles D Mabry, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

C4953 Issued in AR

Practice address

1609 W 40TH Ave Ste 403
Pine Bluff, AR 71603-6365

Phone

(870) 535-8280

Fax

(870) 535-5458

NPI assigned

Oct 7, 2005

Last updated

Oct 11, 2023By 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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

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.

Enrollment records 1

Specialty

General SurgeryAlso: Thoracic Surgery, Vascular Surgery

Education

University of Arkansas College of Medicine, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson Hospital Association, IncGroup PAC ID 8123927431, 80 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charlesmabry@jrmc.allscriptsdirect.net

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.

• Jefferson Hospital Association, Inc

  • Pulmonary Disease Physician
  • Pine Bluff, AR
  • NPI 1932157674

  Surgery

  Medicare reassignment Care Compare group NPD
• Surgeons of South Arkansas, PA

  • Surgery Physician
  • Pine Bluff, AR
  • NPI 1952367625
  Authorized official Same address or phone

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

• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Care Compare affiliation

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1225026875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716132650",
            "telephone_number": "870-541-7211",
            "fax_number": "870-541-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE STE 403",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036365",
            "telephone_number": "870-535-8280",
            "fax_number": "870-535-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABRY",
        "first_name": "CHARLES",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AR",
            "license": "C4953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104825001",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charlesmabry@jrmc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "1609 W 40th Ave Ste 403",
            "city": "Pine Bluff",
            "state": "AR",
            "country_code": "US",
            "postal_code": "716036365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dixie Lozano Lopez, DDS
• Lula Mae's Day Center
• Don Lum, M.D.
• David A Lupo, M.D.
• John Ora Lytle, M.D.
• Scott Aaron Mabry, CADC, CCS
• Caylin Mack
• Christopher Mack, MHPP
• Lori Maddox, MS RD LD
• Magnifique, Inc. (Supreme Medical Supply)

• Surgery Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.