NPIMap

Individual provider Active NPI

Charles William Stout, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Pueblo, CO
National Provider Identifier
1497756597
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
48744 Issued in CO
Practice address
3670 Parker Blvd
Suite 101
Pueblo, CO 81008-2285
Phone
(719) 564-1544
Fax
(719) 924-1593
NPI assigned
Aug 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X 33411 AZ
Cardiovascular Disease Physician 207RC0000X 33411 AZ
Clinical Cardiac Electrophysiology Physician 207RC0001X 48744 CO Primary

Addresses

Primary practice location

3670 Parker Blvd
Suite 101
Pueblo, CO 81008-2285

Mailing address

3670 Parker Blvd
Suite 101
Pueblo, CO 81008-2285
Phone (719) 564-1544

Other identifiers 2

IdentifierTypeStateIssuer
P00997270OtherCORAILROAD MEDICARE
01180773MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20100914000218 CO Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4284696303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Hahnemann University College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

3670 Parker Blvd
Suite 101
Pueblo, CO 81008-2285
Phone (719) 562-2900

Hospital & facility affiliations

  • Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020
  • Prowers Medical Center Hospital, Lamar, CO, CCN 061323

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33411AZMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Aug 2, 2025 Accepting new patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Hallmark Health Medical Associates Inc Past Accepting new patients
North Phoenix Heart Center Cardiovascular Disease Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

3670 Parker Blvd
Pueblo, CO 81008
Phone (719) 562-2900

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

3670 Parker Blvd
Ste 101
Pueblo, CO 81008
Phone (719) 562-2900

Organizations & group practices 4

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1497756597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 PARKER BLVD",
            "address_2": "SUITE 101",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082285",
            "telephone_number": "719-564-1544",
            "fax_number": "719-924-1593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 PARKER BLVD",
            "address_2": "SUITE 101",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082285",
            "telephone_number": "719-564-1544",
            "fax_number": "719-924-1593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "AZ",
            "license": "33411",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "33411",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CO",
            "license": "48744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00997270",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01180773",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.