Charles Bellanger, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1065 Issued in AZ

Practice address

1300 N 12TH St Ste 301
Phoenix, AZ 85006-2813

Phone

(602) 239-6968

Fax

(602) 239-4144

NPI assigned

Jul 11, 2006

Last updated

Feb 15, 2008By 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Arizona Emergency Specialist, PC

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1063446227
  NPD (past)
• Emergency Physicians Professional Association LTD

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1114931490
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203033600000",
    "number": "1407880669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6032 W WILLOW AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853041101",
            "telephone_number": "623-979-4699",
            "fax_number": "623-878-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST STE 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062813",
            "telephone_number": "602-239-6968",
            "fax_number": "602-239-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLANGER",
        "first_name": "CHARLES",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2008-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "1065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103391-06",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Bellack, D.D.S.
• Christa Bellack, MD
• Bellage Eye LLC
• Thomas Joseph Bellama, PT, DPT, OCS
• Pallavi Bellamkonda, M.D.
• Maria Rose Bellantoni, MD
• Mark Bellefeuille, RN
• Pauline Belleh, MS
• Janice Marie Bellezza, OTR
• Anne Bello, BHT, BA

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; 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.