NPIMap

Individual provider Active NPI

Charles Robert Phillips, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Portland, OR
National Provider Identifier
1518064385
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
CV2103421 Issued in IN
Practice address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone
(503) 494-1620
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X MD17331 OR
Critical Care Medicine (Internal Medicine) Physician 207RC0200X CV2103421 IN Primary

Addresses

Primary practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Mailing address

1700 SW Martha St
Portland, OR 97239-2716
Phone (503) 709-8865

Other practice location 1

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone (260) 672-6637

Other identifiers 1

IdentifierTypeStateIssuer
038682MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, TN, WV3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040901000407 OR Practitioner - Internal MedicinePractitioner - Family Practice 1254306368 Reassigns benefits to 1 organization
I20200106002115 TN Practitioner - Internal Medicine 1254306368 Reassigns benefits to 2 organizations
I20231026003900 WV Practitioner - Critical Care (Intensivists) 1254306368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
George Washington University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3100 Maccorkle Ave SE
Suite 205
Charleston, WV 25304-1228
Phone (304) 388-2303

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CV2103421INMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Aug 23, 2023 Accepting new patients
McKenzie Physician Services LLC CurrentSince Jul 12, 2023 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Charleston Area Medical Center Inc CurrentSince Aug 23, 2023 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Dec 14, 2020 Accepting new patients
App of Tennessee HM, PLLC CurrentSince Dec 1, 2019 Accepting new patients
Summa Physicians LLC Current Accepting new patients
Blue Ridge Medical Management Corporation Critical Care Medicine CurrentSince Dec 14, 2020 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

1077 Gorge Blvd
Akron, OH 44310
Phone (234) 312-5691

525 E Market St
Akron, OH 44304
Phone (330) 375-6350

1750 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-0333

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

651 Dunlop Ln
Clarksville, TN 37040
Phone (931) 502-1000

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

400 N State of Franklin Rd
Rm 2746
Johnson City, TN 37604
Phone (423) 431-2727

7565 Dannaher Dr
Powell, TN 37849
Phone (865) 545-8000

2835 Highway 231 N
Shelbyville, TN 37160
Phone (931) 685-5433

3100 Maccorkle Ave SE
Ste 205
Charleston, WV 25304
Phone (304) 388-2303

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

Interoperability endpoints

  • Direct secure messaging: cphillips101300@direct.covenanthealthcare.com

Organizations & group practices 9

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 11

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1518064385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 SW MARTHA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392716",
            "telephone_number": "503-709-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-1620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11109 Parkview Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451701",
            "country_code": "US",
            "telephone_number": "260-672-6637",
            "fax_number": "260-458-5355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CHARLES",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "OR",
            "license": "MD17331",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IN",
            "license": "CV2103421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038682",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.