NPIMap

Individual provider Active NPI

Charles A Everly, M.D.

  • Emergency Medicine Physician
  • Plattsburgh, NY
National Provider Identifier
1528148335
Registry record updated Nov 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
264696 Issued in NY
Practice address
75 Beekman St
Plattsburgh, NY 12901-1438
Phone
(518) 562-7371
Fax
(518) 562-7372
NPI assigned
Oct 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 264696 NY Primary

Addresses

Primary practice location

75 Beekman St
Plattsburgh, NY 12901-1438

Mailing address

PO Box 2868
Plattsburgh, NY 12901-0259
Phone (518) 562-7900

Other identifiers 2

IdentifierTypeStateIssuer
528200OtherAHCCCS
930128016OtherRAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, NY2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20100720000851 AZ Practitioner - Emergency Medicine 4385776749 Reassigns benefits to 1 organization
I20120822000798 NY Practitioner - Emergency Medicine 4385776749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tec Emergency Physicians of Arizona, LLCGroup PAC ID 6204256084, 155 clinicians

Practice addresses (Care Compare)

1064 E Ray Rd
Chandler, AZ 85225-1542
Phone (888) 732-3317

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
264696NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tec Emergency Physicians of Arizona, LLC CurrentSince Aug 13, 2020 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Emergency Medicine CurrentSince Aug 7, 2012 Accepting new patients

Locations

1064 E Ray Rd
Chandler, AZ 85225
Phone (480) 494-5100

7171 S 51st Ave
Laveen, AZ 85339
Phone (623) 584-5100

1419 W Hunt Hwy
San Tan Vly, AZ 85143
Phone (480) 245-4300

5125 S Rural Rd
Tempe, AZ 85282
Phone (480) 306-8780

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

Organizations & group practices 2

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 9

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415664000000",
    "number": "1528148335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2868",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129010259",
            "telephone_number": "518-562-7900",
            "fax_number": "518-562-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 BEEKMAN ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011438",
            "telephone_number": "518-562-7371",
            "fax_number": "518-562-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERLY",
        "first_name": "CHARLES",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2014-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "264696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "528200",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "930128016",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.