Individual provider Active NPI

Charles Christian Anderson, MD

  • Pediatric Cardiology Physician
  • Spokane, WA
National Provider Identifier
1316990666
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD00041066 Issued in WA
Practice address
101 W 8TH Ave
Suite 4300
Spokane, WA 99204-2307
Phone
(509) 747-6707
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X MD00041066 WA
Pediatric Cardiology Physician 2080P0202X M-8783 ID
Pediatric Cardiology Physician 2080P0202X MD00041066 WA Primary

Addresses

Primary practice location

101 W 8TH Ave
Suite 4300
Spokane, WA 99204-2307

Mailing address

PO Box 421
Liberty Lake, WA 99019-0421
Phone (509) 747-6707

Other identifiers 1

IdentifierTypeStateIssuer
806322000MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address canderson219567@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20050920000580 WA Practitioner - Pediatric MedicinePractitioner - Interventional CardiologyPractitioner - Other (Physician) 0446284467 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Baylor College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

200 Lilly Rd NE
Suite C
Olympia, WA 98506-5080
Phone (360) 933-0368

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Sep 23, 2024 Accepting new patients
Providence Health & Services Washington CurrentSince Sep 15, 2015 Accepting new patients
Multicare Health System CurrentSince Sep 23, 2024 Accepting new patients
Multicare Health System Current Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

700 S Main St
Moscow, ID 83843
Phone (208) 746-7555

1200 E Columbia Ave
Colville, WA 99114
Phone (509) 684-3701

821 E Broadway Ave
Ste 5
Moses Lake, WA 98837

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

825 SE Bishop Blvd
Ste 140
Pullman, WA 99163
Phone (509) 334-4498

101 W 8th Ave
Ste 100
Spokane, WA 99204
Phone (509) 474-2880

101 W 8th Ave
Ste 4300
Spokane, WA 99204
Phone (509) 474-6707

101 W 8th Ave
#4300
Spokane, WA 99204
Phone (509) 747-6707

105 W 8th Ave
Ste 6045
Spokane, WA 99204
Phone (509) 455-3676

101 W 8th Ave
Spokane, WA 99204
Phone (509) 474-3181

Interoperability endpoints

  • Direct secure messaging: canderson219567@wm.providencedirect.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1316990666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190421",
            "telephone_number": "509-747-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 8TH AVE",
            "address_2": "SUITE 4300",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "509-747-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "CHARLES",
        "middle_name": "CHRISTIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "WA",
            "license": "MD00041066",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "ID",
            "license": "M-8783",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "WA",
            "license": "MD00041066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806322000",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "canderson219567@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "101 W 8th Ave",
            "address_2": "Suite 4300",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992042307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.