NPIMap

Individual provider Active NPI

Charles Howard Rose, MD

  • Internal Medicine Physician
  • Bloomington, IN
National Provider Identifier
1477544153
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01054413A Issued in IN
Practice address
2205 W Sudbury Dr
Suite a
Bloomington, IN 47403-3737
Phone
(812) 961-1540
Fax
(812) 961-1535
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01054413A IN Primary

Addresses

Primary practice location

2205 W Sudbury Dr
Suite a
Bloomington, IN 47403-3737

Mailing address

2205 W Sudbury Dr
Suite a
Bloomington, IN 47403-3737
Phone (812) 961-1540

Other identifiers 3

IdentifierTypeStateIssuer
200398080MedicaidIN
P00235073OtherINRAILROAD MEDICARE
000000362446OtherINBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20050502000936 IN Practitioner - Internal Medicine 4587603246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2205 W Sudbury Dr
Suite a
Bloomington, IN 47403-3814
Phone (812) 961-1540

2205 W Sudbury Dr a
Bloomington, IN 47403-3814

Hospital & facility affiliations

  • Elara Caring Home health agency, Kokomo, IN, CCN 157586
  • Amedisys Home Health Home health agency, Bloomington, IN, CCN 157578
  • Indiana University Health Bloomington Hospital Hospital, Bloomington, IN, CCN 150051
  • Monroe Hospital Hospital, Bloomington, IN, CCN 150183
  • Indiana University Health Bedford Hospital Hospital, Bedford, IN, CCN 151328
  • Indiana University Health Hospital, Indianapolis, IN, CCN 150056
  • Columbus Regional Hospital Hospital, Columbus, IN, CCN 150112

Merit-based Incentive Payment System (MIPS)

Final score
23.46 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
78.21

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rose Internal Medicine, P.C. Internal Medicine CurrentSince May 2, 2005 Accepting new patients
Bloomington Cardiology PC Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

2205 W Sudbury Dr
Ste A
Bloomington, IN 47403
Phone (812) 961-1540

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JHCJDD/Endpoint/JHCJDD
  • FHIR API: https://fhir4.healow.com/fhir/r4/JHCJDD

Organizations & group practices 3

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 8

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1477544153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 W SUDBURY DR",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033737",
            "telephone_number": "812-961-1540",
            "fax_number": "812-961-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 W SUDBURY DR",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033737",
            "telephone_number": "812-961-1540",
            "fax_number": "812-961-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "CHARLES",
        "middle_name": "HOWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01054413A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200398080",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00235073",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000362446",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.