NPIMap

Individual provider Active NPI

Charles C Gregory, DO PA

  • Family Medicine Physician
  • Portland, TX
National Provider Identifier
1477581221
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L7737 Issued in TX
Practice address
311B Buddy Ganem
Portland, TX 78374-3233
Phone
(361) 643-9800
Fax
(361) 643-5112
NPI assigned
Jun 29, 2006
Last updated
Jun 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X L7737 TX
Family Medicine Physician 207Q00000X L7737 TX Primary

Addresses

Primary practice location

311B Buddy Ganem
Portland, TX 78374-3233

Mailing address

PO Box 903
Portland, TX 78374-0903
Phone (361) 643-9800

Other identifiers 2

IdentifierTypeStateIssuer
8U3260OtherTXINDIVIDUAL BCBS
178461302MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20051028000254 TX Practitioner - Family Practice 7113944257 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charles Gregory DO PAGroup PAC ID 6002838919, 3 clinicians

Practice addresses (Care Compare)

1500 Wildcat Dr
Suite C
Portland, TX 78374-2826
Phone (361) 643-9800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions21
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Physician Assistant

State licenses

LicenseStateTypeSpecialty
L7737TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charles Gregory, DO PA Family Medicine CurrentSince Aug 3, 2005 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
Step Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

1500 Wildcat Dr
Ste C
Portland, TX 78374
Phone (361) 643-9800

311B Buddy Ganem Dr
Portland, TX 78374
Phone (361) 643-9800

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1477581221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 903",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783740903",
            "telephone_number": "361-643-9800",
            "fax_number": "361-643-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311B BUDDY GANEM",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783743233",
            "telephone_number": "361-643-9800",
            "fax_number": "361-643-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREGORY",
        "first_name": "CHARLES",
        "middle_name": "C",
        "credential": "DO PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "L7737",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L7737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL BCBS",
            "identifier": "8U3260",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178461302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, TX

Sources for this page

Verify at the official NPI Registry.