NPIMap

Individual provider Active NPI

Charlie C Pan, MD

  • Radiation Oncology Physician
  • Ann Arbor, MI
National Provider Identifier
1407948805
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
54475-20 Issued in WI
Practice address
1500 East Medical Center Dr
B2 Floor University Hospital RM C490
Ann Arbor, MI 48109-0010
Phone
(734) 936-4300
NPI assigned
Sep 29, 2006
Last updated
Dec 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 4301074664 MI
Radiation Oncology Physician 2085R0001X 54475-20 WI Primary

Addresses

Primary practice location

1500 East Medical Center Dr
B2 Floor University Hospital RM C490
Ann Arbor, MI 48109-0010

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

1580 Commanche Ave
Green Bay, WI 54313-5751
Phone (920) 435-8326

Other identifiers 1

IdentifierTypeStateIssuer
4660707MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101108001414 WI Practitioner - Radiation Oncology 8921077165 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
State University of New York at Buffalo School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians
Newtro SCGroup PAC ID 7315437365, 7 clinicians

Practice addresses (Care Compare)

1580 Commanche Ave
Green Bay, WI 54313-5751
Phone (920) 435-8326

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 358-1520

2500 E Capital Dr
Appleton, WI 54911-8735
Phone (920) 454-3300

2820 Roosevelt Rd
Marinette, WI 54143-3834
Phone (715) 735-5225

820 Arbutus Ave
Oconto, WI 54153-2004
Phone (920) 835-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301074664MIMDRadiation Oncology Physician
54475-20WIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc CurrentSince May 1, 2010 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Aug 1, 2017 Accepting new patients
Bellin Memorial Hospital Inc CurrentSince May 1, 2010 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Newtro SC CurrentSince Sep 29, 2025 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Oconto Hospital & Medical Center, Inc. CurrentSince Aug 1, 2017 Accepting new patients
Radiology Associates of Appleton, S.C. Radiation Oncology CurrentSince Oct 30, 2025 Accepting new patients
Radiation Oncology Alliance Radiation Oncology Past Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

2500 E Capitol Dr
Appleton, WI 54911
Phone (920) 738-4600

2500 E Capitol Dr
Ste 1100
Appleton, WI 54911
Phone (920) 358-1573

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

1580 Commanche Ave
Green Bay, WI 54313
Phone (920) 431-5687

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

Interoperability endpoints

  • Direct secure messaging: cpan42022@direct.thedacare.org

Organizations & group practices 10

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.

Hospital & facility affiliations 9

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1407948805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "B2 FLOOR UNIVERSITY HOSPITAL RM C490",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481090010",
            "telephone_number": "734-936-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1580 Commanche Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543135751",
            "country_code": "US",
            "telephone_number": "920-435-8326",
            "fax_number": "920-430-4659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAN",
        "first_name": "CHARLIE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "4301074664",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "WI",
            "license": "54475-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4660707",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.