Charles Shane Medlock, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME8722 Issued in FL

Practice address

5153 N 9TH Ave Ste 207
Pensacola, FL 32504-5705

Phone

(850) 416-5050

Fax

(850) 416-5022

NPI assigned

Sep 3, 2008

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Obstetrics/Gynecology

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sacred Heart Health System IncGroup PAC ID 3779491386, shared by 6 NPIs, 373 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.medlock.1@9582.direct.athenahealth.com

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.

• Rule One LLC

  • Obstetrics & Gynecology Physician
  • Pensacola, FL
  • NPI 1730503905
  Medicare reassignment NPD
• Sacred Heart Health System, Inc.

  • Family Medicine Physician
  • Pensacola, FL
  • NPI 1144271586
  Medicare reassignment NPD
• Sacred Heart Health System, Inc.

  • Ambulatory Family Planning Facility
  • Pensacola, FL
  • NPI 1962453308
  Medicare reassignment NPD
• Sacred Heart Health System Inc

  • Community/Retail Pharmacy
  • Pensacola, FL
  • NPI 1366260739
  NPD
• Sacred Heart Health System, Inc.

  • Hematology & Oncology Physician
  • Pensacola, FL
  • NPI 1326099763
  NPD
• Florida Medical Practice Plan Inc

  • General Practice Physician
  • Tallahassee, FL
  • NPI 1326386293
  NPD (past)
• Sacred Heart Health System, Inc.

  • Primary Care Clinic/Center
  • Pensacola, FL
  • NPI 1043261498
  NPD (past)

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

• Sacred Heart Health System, Inc.

  • General Acute Care Hospital
  • Pensacola, FL
  • NPI 1922032424
  Care Compare affiliation

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544054400000",
    "number": "1619125671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-416-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5153 N 9TH AVE STE 207",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325045705",
            "telephone_number": "850-416-5050",
            "fax_number": "850-416-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLOCK",
        "first_name": "CHARLES",
        "middle_name": "SHANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2018-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME8722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Professional Agency Inc
• Medical Services of America Inc
• Jennifer Medina, SLP
• Judith Medina, MS, RDN, LD
• Lora Medley
• Christina Medrano, PA-C
• Mefl, LLC
• Megan M Stodard PHD LLC
• Anna Megenhardt, CPT, DO
• Selma Mehmedovic, MSN, APRN

• Obstetrics & Gynecology Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; 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.