Active NPI
Charles Hathaway Nicholson, MD
- Anesthesiology Physician
- Raleigh, NC
National Provider Identifier
1609987502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 30439
- Practice address
- 4420 Lake Boone TRL
Raleigh, NC 27607-7505 - Phone
- (919) 784-3034
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 30439 | NC | Primary |
| Interventional Pain Medicine Physician | 208VP0014X | 30439 | NC |
Addresses
Primary practice location
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Mailing address
PO Box 18139
Raleigh, NC 27619-8139
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89132EO | Medicaid | NC | |
| 6715093 | Other | NC | CIGNA |
| 21504 | Other | NC | PARTNERS |
| 57289 | Other | NC | MEDCOST |
| 132EO | Other | NC | BCBS NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perioperative Medicine Consultants, LLC | Anesthesiology | Past | Accepting new patients |
| Anesthesia Resources of the Carolinas, P.a. | Anesthesiology | Past | Accepting new patients |
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.
-
- Pain Medicine (Anesthesiology) Physician
- Dunn, NC
- NPI 1336185974
-
- Pain Medicine (Anesthesiology) Physician
- Mullins, SC
- NPI 1598850257
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197331200000",
"number": "1609987502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18139",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276198139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4420 LAKE BOONE TRL",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077505",
"telephone_number": "919-784-3034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "CHARLES",
"middle_name": "HATHAWAY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NC",
"license": "30439",
"primary": true
},
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "NC",
"license": "30439",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89132EO",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6715093",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "21504",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "57289",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "132EO",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.