Padmini Charles, MD – Family Medicine Physician

Key facts

NPI: 1477522977
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: R6353 (MO)
Practice address: 180 Industrial Dr
Festus, MO 63028
Phone: (636) 937-8989
NPI assigned: Mar 16, 2006
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

Jefferson Physician Network, LLC Vascular Surgery Physician · Festus, MO · NPI 1558508606

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
R6353	MO	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Jefferson Physician Network, LLC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	R6353	MO	Yes

Addresses

Primary practice location

180 Industrial Dr
Festus, MO 63028

Mailing address

180 Industrial Dr
Festus, MO 63028
Phone (636) 937-8989

Other identifiers

Identifier	Type	State	Issuer
200335107	Medicaid	MO

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2013.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362614400000",
    "number": "1477522977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 INDUSTRIAL DR",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "63028",
            "telephone_number": "636-937-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 INDUSTRIAL DR",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "63028",
            "telephone_number": "636-937-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "PADMINI",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2013-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R6353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200335107",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

All providers in Festus, MO · Family Medicine Physician in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.