Individual provider Active NPI

Charles Butcher Hutton II, PA-C

  • Physician Assistant
  • Thomasville, NC
National Provider Identifier
1376269175
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-12608 Issued in NC
Practice address
903 Randolph St Ste 1
Thomasville, NC 27360-6370
Phone
(336) 475-7163
Fax
(336) 475-1199
NPI assigned
Oct 13, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-12608 NC Primary

Addresses

Primary practice location

903 Randolph St Ste 1
Thomasville, NC 27360-6370

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221130000250 NC Practitioner - Physician Assistant 7315315033 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473

903 Randolph St
Suite 1
Thomasville, NC 27360-6370
Phone (336) 475-7163

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Novant Health Thomasville Medical Center Hospital, Thomasville, NC, CCN 340085

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-12608NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. CurrentSince Nov 12, 2022 Accepting new patients
Forsyth Memorial Hospital CurrentSince Nov 12, 2022 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

903 Randolph St
Ste 1
Thomasville, NC 27360
Phone (336) 475-7163

903 Randolph St
Thomasville, NC 27360
Phone (336) 475-7163

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

Interoperability endpoints

  • Direct secure messaging: chutton1093334@direct.novanthealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1376269175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 RANDOLPH ST STE 1",
            "city": "THOMASVILLE",
            "state": "NC",
            "postal_code": "273606370",
            "telephone_number": "336-475-7163",
            "fax_number": "336-475-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTTON",
        "first_name": "CHARLES",
        "middle_name": "BUTCHER",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, NC

Sources for this page

Verify at the official NPI Registry.