NPIMap

Individual provider Active NPI

Charles D Richardson, M.D.

  • Family Medicine Physician
  • Ogden, UT
National Provider Identifier
1619105236
Registry record updated Dec 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
74194651205 Issued in UT
Practice address
4403 Harrison Blvd Ste 700a
Ogden, UT 84403-3295
Phone
(801) 387-5300
NPI assigned
Jun 23, 2009
Last updated
Dec 2, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 74194651205 UT Primary

Addresses

Primary practice location

4403 Harrison Blvd Ste 700a
Ogden, UT 84403-3295

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 387-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091021000391 UT Practitioner - Family Practice 8123165370 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tanner Memorial ClinicGroup PAC ID 4284547985, 251 clinicians

Practice addresses (Care Compare)

2121 N 1700
Layton, UT 84041-8803
Phone (801) 773-4840

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74194651205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Memorial Clinic CurrentSince Jun 1, 2017 Accepting new patients
Tanner Memorial Clinic CurrentSince Jun 1, 2017 Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
Ihc Health Services Inc CurrentSince Sep 2, 2010 Accepting new patients
Granger Medical Specialists LLC Past Accepting new patients
Rosenberg Cooley Metcalf LC Past Accepting new patients
Granger Medical Clinic, PC PastSince Apr 11, 2016 Accepting new patients

Locations

4403 Harrison Blvd
Ogden, UT 84403
Phone (801) 387-2800

4403 Harrison Blvd
Ste 700A
Ogden, UT 84403
Phone (801) 387-5322

1380 E Medical Center Dr
St George, UT 84790
Phone (435) 251-2992

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Interoperability endpoints

  • Direct secure messaging: charles.richardson.p1@direct.tannerclinic.nextgenshare.com

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259712000000",
    "number": "1619105236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-387-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD STE 700A",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033295",
            "telephone_number": "801-387-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "CHARLES",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "74194651205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.