NPIMap

Individual provider Active NPI

Charles Randall Hutton, D.D.S.

  • General Practice Dentistry
  • Winamac, IN
National Provider Identifier
1265545461
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007612A Issued in IN
Practice address
201 E Adams St
Winamac, IN 46996-1567
Phone
(574) 946-6747
Fax
(574) 946-4323
NPI assigned
Aug 15, 2006
Last updated
Jul 8, 2007By the provider in NPPES
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
General Practice Dentistry 1223G0001X 12007612A IN Primary

Addresses

Primary practice location

201 E Adams St
Winamac, IN 46996-1567

Mailing address

201 E Adams St
Winamac, IN 46996-1567
Phone (574) 946-6747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20150423001308 IN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8527287333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12007612AINMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Charles R. Hutton D.D.S.,PC Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pulaski Memorial HospitalWinamac, IN, CCN 151305 Hospital Corporate Director (14.29%) Aug 27, 2002
Pulaski Memorial HospitalWinamac, IN, CCN 15Z305 Hospital Corporate Director (14.29%) Aug 27, 2014
Pulaski Health Care CenterWinamac, IN, CCN 155660 Skilled nursing facility Corporate Director (14.29%) Aug 27, 2014
Parkview HavenFrancesville, IN, CCN 155746 Skilled nursing facility Corporate Director (14.29%) Aug 27, 2002
Kingston Health Center of Fort WayneFort Wayne, IN, CCN 155479 Skilled nursing facility Trustee of the SNF Dec 16, 2025
Briarcliff Health & Rehabilitation CenterSouth Bend, IN, CCN 155831 Skilled nursing facility Corporate Director (100%) Jan 1, 2024
South Shore Health & Rehabilitation CenterGary, IN, CCN 155530 Skilled nursing facility Corporate Director (100%) Jan 1, 2024
Asbury Towers Health Care CenterGreencastle, IN, CCN 155758 Skilled nursing facility Managing Control - Governing Body Jul 1, 2024
Healthwin Health & RehabilitationSouth Bend, IN, CCN 155153 Skilled nursing facility Trustee of the SNF Jan 8, 2025
Pulaski Memorial HospitalWinamac, IN, CCN 158512 Rural health clinic Corporate Director Aug 27, 2002
Pulaski Memorial Hospital Francesville Family MedicineFrancesville, IN, CCN 158528 Rural health clinic Corporate Director Aug 27, 2002
Pulaski Memorial Hospital North Judson Family MedicineNorth Judson, IN, CCN 158527 Rural health clinic Corporate Director Aug 27, 2002
Pulaski Memorial Hospital Knox Medical CenterKnox, IN, CCN 158554 Rural health clinic Corporate Director Aug 27, 2002
Pulaski Memorial Hospital Culver Medical CenterCulver, IN, CCN 158581 Rural health clinic Corporate Director Aug 27, 2002

Owned or controlled facilities with NPI records 14

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 14

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265545461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E ADAMS ST",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "469961567",
            "telephone_number": "574-946-6747",
            "fax_number": "574-946-4323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E ADAMS ST",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "469961567",
            "telephone_number": "574-946-6747",
            "fax_number": "574-946-4323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTTON",
        "first_name": "CHARLES",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007612A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winamac, IN

Sources for this page

Verify at the official NPI Registry.