Individual provider Active NPI

Charlene Hansen, M.D.

  • Internal Medicine Physician
  • Sacramento, CA
National Provider Identifier
1366556748
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
168946 Issued in CA
Practice address
1500 21St St
Sacramento, CA 95811-5216
Phone
(916) 443-3299
NPI assigned
Aug 19, 2006
Last updated
Mar 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 31508 IA
Internal Medicine Physician 207R00000X 168946 CA Primary

Addresses

Primary practice location

1500 21St St
Sacramento, CA 95811-5216

Mailing address

1500 21St St
Sacramento, CA 95811-5216
Phone (916) 443-3299

Other identifiers 2

IdentifierTypeStateIssuer
417198MedicaidAZ
000R7592MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 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

Enrollment IDStateProvider typePAC IDDetails
I20150326001229 TX Practitioner - Internal Medicine 2668799891 Reassigns benefits to 1 organization
I20250203000512 NM Practitioner - Internal Medicine 2668799891 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
168946CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo Pintado Clinic CurrentSince Feb 21, 2015 Accepting new patients
DHHS PHS Naihs Crownpoint Hospital Current Accepting new patients
American Current Care P.a. CurrentSince Jan 20, 2025 Accepting new patients
Thoreau Clinic CurrentSince Feb 21, 2015 Accepting new patients
American Current Care, P.a. CurrentSince Jan 20, 2025 Accepting new patients

Locations

720 Saint Michaels Dr
Ste D
Santa Fe, NM 87505
Phone (505) 438-9402

5080 Spectrum Dr
Ste 1200W
Addison, TX 75001

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1366556748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 21ST ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115216",
            "telephone_number": "916-443-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 21ST ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115216",
            "telephone_number": "916-443-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "CHARLENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "31508",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "168946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "417198",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000R7592",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.