Charles Nicholas Eisenhauer IV, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

71735 Issued in MN

Practice address

6029 Walnut Grove Rd Ste 404
Memphis, TN 38120-2112

Phone

(901) 726-1056

NPI assigned

Apr 1, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN, MN2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wcoceisenh@yourcarecommunity.org

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.

• Saint Francis Physician Network, LLC

  • Family Medicine Physician
  • Covington, TN
  • NPI 1295258002
  Medicare reassignment NPD
• Avera Marshall

  • Critical Access Hospital
  • Marshall, MN
  • NPI 1568401016
  Medicare reassignment NPD
• Rural Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Worthington, MN
  • NPI 1215317375
  Medicare reassignment NPD
• Avera Marshall

  • Optometrist
  • Marshall, MN
  • NPI 1487422465
  NPD
• Rural Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Marshall, MN
  • NPI 1740944602
  NPD
• Avera Marshall

  • Multi-Specialty Clinic/Center
  • Marshall, MN
  • NPI 1962641936
  NPD (past)

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

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1275775587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S BRUCE ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581934",
            "telephone_number": "507-537-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6029 WALNUT GROVE RD STE 404",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202112",
            "telephone_number": "901-726-1056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3320 Marcus Cv",
            "address_purpose": "LOCATION",
            "city": "Bartlett",
            "state": "TN",
            "postal_code": "381342800",
            "country_code": "US",
            "telephone_number": "901-607-2934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EISENHAUER",
        "first_name": "CHARLES",
        "middle_name": "NICHOLAS",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-01",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "P",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "71735",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "57079",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN STATE LICENSE",
            "identifier": "57079",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY STATE LICENSE",
            "identifier": "48491",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0148667",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100133120",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Francis Eick, M.D.
• Anas Eid
• Jennifer Renee Eilert, PTA
• Stephanie L Einhaus, MD
• Robert Martin Eiseman, MD
• Eisenhower Army Medical Center
• Elizabeth Danielle Eisenman, MSN, APRN, FNP-BC
• Gerald A Eisenstatt, OD
• Ashley Maree Eishen, RN
• Rosita Nnenna Ekem

• Surgery Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.