Individual provider Active NPI

Charles Engle, PA-C

  • Physician Assistant
  • Bridgeport, CT
National Provider Identifier
1447652490
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
23.003178 Issued in CT
Practice address
982 E Main St
Bridgeport, CT 06608-1913
Phone
(203) 696-3260
NPI assigned
Sep 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 23.003178 CT Primary
Physician Assistant 363A00000X 017947 NY

Addresses

Primary practice location

982 E Main St
Bridgeport, CT 06608-1913

Mailing address

706 Larson Dr
Danbury, CT 06810-7373

Other identifiers 1

IdentifierTypeStateIssuer
1118886OtherCTNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141104001032 CT Practitioner - Physician Assistant 1759503907 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
23.003178CTMDPhysician Assistant
017947NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optimus Health Care Inc CurrentSince Oct 1, 2014 Accepting new patients
Optimus Health Care Inc CurrentSince Oct 1, 2014 Accepting new patients

Locations

982 E Main St
Bridgeport, CT 06608
Phone (203) 696-3260

471 Barnum Ave
Bridgeport, CT 06608
Phone (203) 333-6864

Interoperability endpoints

  • Direct secure messaging: cengle350860@direct.ynhh.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1447652490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 LARSON DR",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068107373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913",
            "telephone_number": "203-696-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGLE",
        "first_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-22",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "23.003178",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017947",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS",
            "identifier": "1118886",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.