Active NPI
Charles Otis Tubbs, MD
- Diagnostic Radiology Physician
- Shelby, NC
National Provider Identifier
1285613570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 98-00721
- Practice address
- 222 N Lafayette St
Suite 01
Shelby, NC 28150-4444 - Phone
- (704) 482-3880
- Fax
- (704) 487-0294
- NPI assigned
- Jan 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 98-00721 | NC | Primary |
Addresses
Primary practice location
222 N Lafayette St
Suite 01
Shelby, NC 28150-4444
Mailing address
222 N Lafayette St
Suite 01
Shelby, NC 28150-4444
Phone (704) 482-3880
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131039 | Medicaid | SC | |
| 8911349 | Medicaid | NC | |
| 19736 | Other | OK | OKLAHOMA MEDICAL LICENSE |
| 13103 | Other | SC | SC MEDICAL LICENSE |
| MD0000019644 | Other | TN | TENNESSEE MEDICAL LICENSE |
| 11349 | Other | NC | NC BLUE CROSS BLUE SHIELD |
| 98-00721 | Other | NC | NC MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 98-00721 | NC | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1285613570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N LAFAYETTE ST",
"address_2": "SUITE 01",
"city": "SHELBY",
"state": "NC",
"postal_code": "281504444",
"telephone_number": "704-482-3880",
"fax_number": "704-487-0294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 N LAFAYETTE ST",
"address_2": "SUITE 01",
"city": "SHELBY",
"state": "NC",
"postal_code": "281504444",
"telephone_number": "704-482-3880",
"fax_number": "704-487-0294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUBBS",
"first_name": "CHARLES",
"middle_name": "OTIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-13",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NC",
"license": "98-00721",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "131039",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8911349",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OKLAHOMA MEDICAL LICENSE",
"identifier": "19736",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SC MEDICAL LICENSE",
"identifier": "13103",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNESSEE MEDICAL LICENSE",
"identifier": "MD0000019644",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC BLUE CROSS BLUE SHIELD",
"identifier": "11349",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC MEDICAL LICENSE",
"identifier": "98-00721",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelby, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.