Active NPI
Jimmie R Charlie, M.D.
- Family Medicine Physician
- Santo Domingo, NM
National Provider Identifier
1366523722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20020019
- Practice address
- 85 West Highway 22
Santo Domingo, NM 87502-0340 - Phone
- (505) 465-3060
- Fax
- (505) 465-3060
- NPI assigned
- Oct 18, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20020019 | NM | Primary |
Addresses
Primary practice location
85 West Highway 22
Santo Domingo, NM 87502-0340
Mailing address
PO Box 340
Santo Domingo Pueblo, NM 87052-0340
Phone (505) 465-3060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85534862 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091211000706 | TX | Practitioner - Family Practice | 7911047543 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Stanford University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kewa Pueblo Health Corporation
Practice addresses (Care Compare)
85 W Hwy 22
Santo Domingo Pueblo, NM 87052-1283
Phone (505) 465-3060
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 12 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20020019 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kewa Pueblo Health Corporation | Current | Accepting new patients | |
| Kewa Pueblo Health Corporation | Past | Accepting new patients | |
| Santo Domingo Health Clinic | Past | Accepting new patients | |
| Cochiti Health Clinic | Past | Accepting new patients | |
| Santa Clara Health Center | Past | Accepting new patients | |
| San Felipe Health Clinic | Past | Accepting new patients |
Locations
85 W Highway 22
Santo Domingo Pueblo, NM 87052
Phone (505) 465-3060
Interoperability endpoints
- jimmie.charlie.p1@direct.kp-hc.nextgenshare.com
Organizations & group practices 7
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.
-
- Federally Qualified Health Center (FQHC)
- Santo Domingo Pueblo, NM
- NPI 1467739888
TX
-
- General Acute Care Hospital
- Cochiti Pueblo, NM
- NPI 1093814691
-
- Community/Behavioral Health Agency
- Santo Domingo Pueblo, NM
- NPI 1336659077
-
- General Acute Care Hospital
- San Felipe, NM
- NPI 1831274851
-
- General Acute Care Hospital
- Espanola, NM
- NPI 1043396377
-
- General Acute Care Hospital
- Santo Domingo Pueblo, NM
- NPI 1376632695
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472774400000",
"number": "1366523722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 340",
"city": "SANTO DOMINGO PUEBLO",
"state": "NM",
"postal_code": "870520340",
"telephone_number": "505-465-3060",
"fax_number": "505-867-6527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85 WEST HIGHWAY 22",
"city": "SANTO DOMINGO",
"state": "NM",
"postal_code": "875020340",
"telephone_number": "505-465-3060",
"fax_number": "505-465-3060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLIE",
"first_name": "JIMMIE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2016-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "20020019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85534862",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santo Domingo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.