Charles A Bagwell, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

050494 Issued in GA

Practice address

100 Doctors Dr Ste C
Douglas, GA 31533-2211

Phone

(912) 384-5832

Fax

(912) 383-8279

NPI assigned

Feb 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in GA

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 Surgery

Education

Medical College of Georgia School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coffee Regional Medical Center IncGroup PAC ID 4587656012, 29 clinicians

Coffee Emergency Group LLCGroup PAC ID 4880834050, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Coffee Regional Medical Center, Inc Hospital, Douglas, GA, CCN 110089

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Coffee Emergency Group LLC

  • Emergency Medicine Physician
  • Douglas, GA
  • NPI 1023353489

  GA

  Medicare reassignment Care Compare group NPD
• Coffee Regional Medical Center, Inc

  • Anesthesiology Physician
  • Douglas, GA
  • NPI 1437120946

  GA

  Medicare reassignment Care Compare group NPD
• Coffee Regional Medical Center, Inc

  • Rural Health Clinic/Center
  • Douglas, GA
  • NPI 1639211956
  Care Compare group NPD
• Coffee Regional Medical Center, Inc

  • General Acute Care Hospital
  • Douglas, GA
  • NPI 1760419527
  Care Compare group
• CRH Physician Practices LLC

  • Surgery Physician
  • Waycross, GA
  • NPI 1154794857

  Surgery

  NPD (past)
• CRH Physician Practices, LLC

  • Urology Physician
  • Douglas, GA
  • NPI 1306359781
  NPD (past)

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

• Coffee Regional Medical Center, Inc

  • General Acute Care Hospital
  • Douglas, GA
  • NPI 1760419527

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1366417479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WARD STREET EXT W",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315331902",
            "telephone_number": "912-384-1477",
            "fax_number": "912-384-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DOCTORS DR STE C",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332211",
            "telephone_number": "912-384-5832",
            "fax_number": "912-383-8279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 E 15th St",
            "address_purpose": "LOCATION",
            "city": "Alma",
            "state": "GA",
            "postal_code": "315102908",
            "country_code": "US",
            "telephone_number": "912-384-5832",
            "fax_number": "912-383-8279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAGWELL",
        "first_name": "CHARLES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "050494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID - 17 JOHNSON ST",
            "identifier": "11D1105865",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE OF GEORGIA",
            "identifier": "341153",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000919729B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000919729C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA LICENSE",
            "identifier": "050494",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "050494",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID - 1309 OCILLA RD STE A",
            "identifier": "11D0265294",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - PALMETTO GBA",
            "identifier": "PTAN P00473716",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACHSTATE",
            "identifier": "129049",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - PALMETTO GBA",
            "identifier": "GROUP #DH1281",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Asf Medical Center Inc
• Sara E Atkinson, LCSW
• Lovelle Waydia Auguste, M.D.
• Stephen John Augustine, D.O.
• Austin Respiratory and Medical Equipment Inc
• Sherry Bailey, FNP-C
• Manish Kumar Bansal, MD
• Akhil Baranwal, MD
• James William Barber, MD
• Lisa A Batten, NP

• All providers in Douglas, GA
• Surgery Physician in Georgia

• 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.
• 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.