Mistie A Charlemagne, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

E-11036 Issued in AR

Practice address

1600 W 40TH Ave
Pine Bluff, AR 71603-6301

Phone

(870) 541-8767

Fax

(870) 541-8761

NPI assigned

Aug 25, 2009

Last updated

Jul 29, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mistie A Mutombo Former name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hospitalist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson Hospital Association, IncGroup PAC ID 8123927431, 80 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071
• CHI-St Vincent Infirmary Hospital, Little Rock, AR, CCN 040007

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Jefferson Hospital Association, Inc

  • Pulmonary Disease Physician
  • Pine Bluff, AR
  • NPI 1932157674
  Medicare reassignment Care Compare group NPD
• Forrest City Physician Services, PLLC

  • Hospitalist Physician
  • Forrest City, AR
  • NPI 1154815181
  Medicare reassignment NPD
• Southeast Arkansas Hospitalists, LLP

  • Hospitalist Physician
  • Pine Bluff, AR
  • NPI 1912374018
  Medicare reassignment NPD
• Jefferson Hospital Association, Inc

  • Rural Health Clinic/Center
  • Crossett, AR
  • NPI 1225799646
  NPD

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

• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Care Compare affiliation
• St Vincent Infirmary Medical Center

  dba St Vincent Infirmary Medical Center - GeroPsych Unit

  • Psychiatric Hospital Unit
  • Little Rock, AR
  • NPI 1710442801
  Care Compare affiliation
• St Vincent Infirmary Medical Center

  dba St. Vincent Health System

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1780684431
  Care Compare affiliation

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1407089436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-936-2038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-8767",
            "fax_number": "870-541-8761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 E Johnson Ave",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724018413",
            "country_code": "US",
            "telephone_number": "870-936-8000",
            "fax_number": "870-936-2038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHARLEMAGNE",
        "first_name": "MISTIE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-25",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD205733",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AR",
            "license": "E-11036",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-11036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTIE",
            "last_name": "MUTOMBO",
            "middle_name": "A",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Charlotte Chapple, CRNA
• Charles a. Clark, MD, PA
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• Ashton Cheatham, PHARM. D.
• Daniel Marion Cheatham, APRN
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• Internal Medicine Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Internal Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.