Charles K Wanich, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

ME36933 Issued in FL

Practice address

245 S Courtenay Parkway
BLDG B
Merritt Island, FL 32952

Phone

(321) 453-5326

Fax

(321) 452-8507

NPI assigned

Sep 22, 2006

Last updated

Oct 26, 2011By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Enrolled in FL

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

NephrologyAlso: Internal Medicine

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brevard Nephrology Group PAGroup PAC ID 3779554985, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rai-S Courtenay-Merritt Island Dialysis facility, Merritt Island, FL, CCN 102553
• Fresenius Kidney Care Cocoa Dialysis facility, Cocoa, FL, CCN 682732
• Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: cwanich22968@epicdirect.hf.org
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72643

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.

• Brevard Nephrology Group PA

  • Nephrology Physician
  • Merritt Island, FL
  • NPI 1003029786
  Medicare reassignment Care Compare group NPD

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

• Bio-Medical Applications of Florida, Inc.

  dba Fresenius Kidney Care Cocoa

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cocoa, FL
  • NPI 1881267698

  Dialysis facility

  Care Compare affiliation Name & address match
• Rai Care Centers of Merritt Island, LLC

  dba Rai - S. Courtenay - Merritt Island

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Merritt Island, FL
  • NPI 1528242849

  Dialysis facility

  Care Compare affiliation Name & address match
• Cape Canaveral Hospital, Inc.

  • General Acute Care Hospital
  • Cocoa Beach, FL
  • NPI 1184691610
  Care Compare affiliation

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1376642355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 S COURTENAY PARKWAY",
            "address_2": "BLDG B",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32952",
            "telephone_number": "321-453-5326",
            "fax_number": "321-452-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S COURTENAY PARKWAY",
            "address_2": "BLDG B",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32952",
            "telephone_number": "321-453-5326",
            "fax_number": "321-452-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANICH",
        "first_name": "CHARLES",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME36933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110202974",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039647800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2168973",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Waller
• Brian Bolivar Walls, MD
• Brittany Walrath, PHARMD
• Denise Ashley Walters, MA. CCC- SLP
• Winifred Jean Wang
• Cheri Warner
• Lori Ann Warren, APRN
• Robin Waters
• Brian Jeffrey Watkins, PHARMD,RPH
• Megan Nichole Watson, DOM

• Nephrology Physician in Merritt Island, FL
• Providers in Merritt Island, FL by specialty
• Nephrology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2011; 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.