NPIMap

Individual provider Active NPI

Charles David Sr., MD

  • Emergency Medicine Physician
  • Wauseon, OH
National Provider Identifier
1396712683
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35057726 Issued in OH
Practice address
725 S Shoop Ave
Wauseon, OH 43567-1702
Phone
(419) 335-2015
NPI assigned
Mar 5, 2006
Last updated
Nov 16, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35057726 OH Primary

Addresses

Primary practice location

725 S Shoop Ave
Wauseon, OH 43567-1702

Mailing address

3501 S Crissey Rd
Monclova, OH 43542-9766
Phone (419) 350-5652

Other identifiers 4

IdentifierTypeStateIssuer
0725666MedicaidOH
810547599071OtherOHCARESOURCE
000000522471OtherOHANTHEM BCBS
5214037MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44877CAMDOrthodontics and Dentofacial Orthopedic Dentist
35057726OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tiffin Emergency Services, LLC Emergency Medicine Past Accepting new patients
Emergency Physicians of Northwest Ohio Inc. Emergency Medicine Past Accepting new patients
Fostoria Hospital Association Past Accepting new patients
Mercy Emergency Care Services, Inc. Emergency Medicine Past Accepting new patients
FCHC Medical Care, LLC Past Accepting new patients
Great Lakes Emergency Medicine Physicians, Inc Emergency Medicine Past Accepting new patients

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, 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": "1141516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1396712683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 S CRISSEY RD",
            "city": "MONCLOVA",
            "state": "OH",
            "postal_code": "435429766",
            "telephone_number": "419-350-5652",
            "fax_number": "419-861-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S SHOOP AVE",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435671702",
            "telephone_number": "419-335-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVID",
        "first_name": "CHARLES",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-05",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35057726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0725666",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "810547599071",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000522471",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5214037",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauseon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.