Roger John Charboneau, D.O.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

4037 Issued in OK

Practice address

1921 Stonecipher Dr
Ada, OK 74820-3439

Phone

(580) 559-0510

Fax

(580) 272-2715

NPI assigned

Sep 23, 2005

Last updated

Aug 10, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chickasaw Nation Division of Health Chickasaw Nation Medical CenterGroup PAC ID 8426957523, 243 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chickasaw Nation Medical Center Hospital, Ada, OK, CCN 370180

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rcharboneau40920@direct.chickasawnationhealth.net

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.

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923

  TX

  Medicare reassignment Care Compare group NPD
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  dba Minticha Apila

  • Home Health Agency
  • Ada, OK
  • NPI 1811739071
  NPD
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  dba Chickasaw Nation DME

  • Durable Medical Equipment & Medical Supplies
  • Ada, OK
  • NPI 1295399095
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923
  Care Compare affiliation
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Tishomingo Clinic

  • Primary Care Clinic/Center
  • Tishomingo, OK
  • NPI 1649330242

  Hospital

  Care Compare affiliation
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Ardmore Clinic

  • Primary Care Clinic/Center
  • Ardmore, OK
  • NPI 1730249186

  Hospital

  Care Compare affiliation
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Purcell Clinic

  • Primary Care Clinic/Center
  • Purcell, OK
  • NPI 1982764395

  Hospital

  Care Compare affiliation
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  • Primary Care Clinic/Center
  • Ada, OK
  • NPI 1962563148

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1609862689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-559-0510",
            "fax_number": "580-272-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-559-0510",
            "fax_number": "580-272-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARBONEAU",
        "first_name": "ROGER",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "OK",
            "license": "4037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "611692300",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00212246",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200009440A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Central Oklahoma Family Medical Center, Inc. (The Clinic Pharmacy on Arlington)
• Central Oklahoma Family Medical Center, Inc.
• Sherri R Chandler, MS
• Toni Chappell, B.A.
• Dan Charboneau, PHYSICAL THERAPIST
• Semira Charboneau, D.O.
• Charles R Vest M.D.
• Scott Charlton, PHARM. D.
• Cameron Chavez, LMSW
• Larry Oliver Chesser, MSW

• Sports Medicine (Orthopaedic Surgery) Physician in Ada, OK
• Providers in Ada, OK by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.