NPIMap

Individual provider Active NPI

Charlene J Hickson, M.D.

  • Otolaryngology Physician
  • Pueblo, CO
National Provider Identifier
1417909938
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
39435 Issued in CO
Practice address
1218 S Pueblo Blvd
Pueblo, CO 81005-1593
Phone
(719) 566-1277
Fax
(719) 566-1257
NPI assigned
May 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 39435 CO Primary

Addresses

Primary practice location

1218 S Pueblo Blvd
Pueblo, CO 81005-1593

Mailing address

1218 S Pueblo Blvd
Pueblo, CO 81005-1593
Phone (719) 566-1277

Other practice location 1

902 Lakeview Ave
Pueblo, CO 81004-3597
Phone (719) 557-5855

Other identifiers 1

IdentifierTypeStateIssuer
50255843MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20060612000083 CO Practitioner - Otolaryngology 8123095544 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

1218 S Pueblo Blvd
Pueblo, CO 81005-1593
Phone (719) 542-1803

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

902 Lakeview Ave
Pueblo, CO 81004-3597
Phone (719) 557-5855

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39435COMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jul 1, 2022 Accepting new patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jul 1, 2022 Accepting new patients
Catholic Health Initiatives Colorado Current Accepting new patients
Greenwood Ear Nose & Throat Specialists PC Otolaryngology Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

902 Lakeview Ave
Pueblo, CO 81004
Phone (719) 557-5855

1304 N Grand Ave
Pueblo, CO 81003
Phone (719) 544-3752

1218 S Pueblo Blvd
Pueblo, CO 81005
Phone (719) 542-1803

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1417909938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 S PUEBLO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051593",
            "telephone_number": "719-566-1277",
            "fax_number": "719-566-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 S PUEBLO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051593",
            "telephone_number": "719-566-1277",
            "fax_number": "719-566-1257"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "902 Lakeview Ave",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810043597",
            "country_code": "US",
            "telephone_number": "719-557-5855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HICKSON",
        "first_name": "CHARLENE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "39435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50255843",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.