Charles Michael Irvin, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

SC002443L Issued in PA

Practice address

1070 Old National Pike
Fredericktown, PA 15333-2114

Phone

(724) 632-6801

Fax

(724) 632-6312

NPI assigned

Dec 16, 2005

Last updated

Apr 29, 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 3

Medicare fee-for-service enrollment

Enrolled in PA

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

Podiatry

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centerville Clinics, Inc.Group PAC ID 7214837202, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.irvin.1@33484.direct.athenahealth.com

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.

• Centerville Clinics, Inc.

  • Family Medicine Physician
  • Fredericktown, PA
  • NPI 1801877048
  Medicare reassignment Care Compare group NPD
• Centerville Clinics, Inc

  • Specialist
  • Fredericktown, PA
  • NPI 1720339393
  NPD
• Centerville Clinics, Inc.

  • Radiologic Technologist
  • Fredericktown, PA
  • NPI 1568566867
  NPD
• Centerville Clinics, Inc.

  • Clinical Medical Laboratory
  • Fredericktown, PA
  • NPI 1811978166
  NPD
• Centerville Clinics, Inc.

  • Cardiovascular Disease Physician
  • Fredericktown, PA
  • NPI 1902887250
  NPD
• Centerville Clinics, Inc.

  • Podiatrist
  • Fredericktown, PA
  • NPI 1922089275
  NPD

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1457337032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRVIN",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC002443L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0984761",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440027",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "032094",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Goodwin
• Danielle M Guerrieri, CRNP
• Scott Robert Hargraves, DPT
• Erin C. Hathaway, B.A.
• Peggy Lynn Heffner, LSW
• Patricia A Johnson
• Bryce James Kesling, FNP-C
• Jessica Jane Kiger, FNP-C
• April Kilpatrick
• Cecilia L Knutsen

• Podiatrist in Fredericktown, PA
• Providers in Fredericktown, PA by specialty
• Podiatrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.