Charles A Kergosien, M.D.
Individual provider Active NPI Internal Medicine Physician · Brookhaven, MS
NPI 1619087541 · NPPES record last updated Jan 18, 2013
Key facts
- NPI
- 1619087541
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 15445 (MS)
- Practice address
- 527 Silver Cross Dr
Brookhaven, MS 39601-2388 - Phone
- (601) 835-0507
- Fax
- (601) 835-2766
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Mississippi School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
527 Silver Cross Dr
Brookhaven, MS 39601-2388
Phone (601) 835-0507
Hospital & facility affiliations
- Sta Home Health Agency of Jackson, Inc. Dba Accentcare Home Health of Jackson
- Deaconess Homecare-Region I I
- Arden Home Health of West Ms, LLC
- St Luke Home Health Services
- King'S Daughters Medical Center-Brookhaven
- Southwest Ms Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.46 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 84.86
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051004000588 | MS | Practitioner - Internal Medicine | 2264467778 | Practice locations: Brookhaven, MS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Interoperability endpoints
- charles.kergosien@bim.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 15445 | MS | Yes |
Addresses
Primary practice location
527 Silver Cross Dr
Brookhaven, MS 39601-2388
Mailing address
PO Box 4177
Brookhaven, MS 39603-6177
Phone (601) 835-0507
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00118411 | Medicaid | MS |
NPI Registry JSON
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358467200000",
"number": "1619087541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4177",
"city": "BROOKHAVEN",
"state": "MS",
"postal_code": "396036177",
"telephone_number": "601-835-0507",
"fax_number": "601-835-2766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "527 SILVER CROSS DR",
"city": "BROOKHAVEN",
"state": "MS",
"postal_code": "396012388",
"telephone_number": "601-835-0507",
"fax_number": "601-835-2766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERGOSIEN",
"first_name": "CHARLES",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2013-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "15445",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00118411",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, MS
- Julie Ross, NP, PLLC Dba Brookhaven Neurobehavioral Clinic
- Janice Karas
- KCRX Brookhaven LLC
- KDMC Physician Clinics LLC
- Margaret Jane Kent
- Greta Louise Keys
- Kembe Keys
- Holly L Kimbrell
- Sarah Kathryn Kimes
- Kindness Healthcare Services LLC
All providers in Brookhaven, MS · Internal Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.