Charles R Robertson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

07359 Issued in MS

Practice address

1573 Medical Park Cir
Tupelo, MS 38801-6580

Phone

(662) 844-9885

Fax

(662) 842-1350

NPI assigned

Sep 15, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• North Mississippi Medical Center Inc

  dba Behavioral Health Center

  • Psychologist
  • Tupelo, MS
  • NPI 1972608347
  Medicare reassignment NPD
• North Mississippi Medcial Center, Inc.

  dba Radiology Consultants

  • Diagnostic Radiology Physician
  • Tupelo, MS
  • NPI 1902762487
  NPD
• North Mississippi Medical Center Inc

  dba NMMC Acute Trauma Clinic

  • Trauma Surgery Physician
  • Tupelo, MS
  • NPI 1528669041
  NPD

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1619073103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1573 MEDICAL PARK CIR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016580",
            "telephone_number": "662-844-9885",
            "fax_number": "662-842-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1573 MEDICAL PARK CIR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016580",
            "telephone_number": "662-844-9885",
            "fax_number": "662-842-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "CHARLES",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "07359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00111465",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Roberts, LMSW
• Lisa Roberts
• Paul Russell Roberts, MD
• Raychal Reed Roberts, PR, DPT
• Steven Bradford Roberts, D.M.D.
• James Michael Robertson, DMD
• Kathryn Micaela Robertson, FNP-BC
• Franchesca Robichaud
• Braxton Lamarr Robins
• Amanda Blair Robinson, NP

• Pediatrics Physician in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.