Charles Abe Andersen

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

151353-1205 Issued in UT

Practice address

9040 Jackson Ave
Tacoma, WA 98431-0001

Phone

(253) 968-3885

Fax

(253) 968-5997

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

Yes

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 UT

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

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1639149479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 28TH AVENUE CT",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983547007",
            "telephone_number": "253-952-2135",
            "fax_number": "253-952-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-3885",
            "fax_number": "253-968-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "CHARLES",
        "middle_name": "ABE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "UT",
            "license": "151353-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anand Pullat DDS PLLC
• Erika M Anattol, ATC
• Anchorbridge Assessments and Referrals LLC
• Nicole M Ancich, DMD
• Laura Andel
• Anderson and Johnson Dentures
• Aarika Dawn Anderson Elter, DMD
• Joseph A Anderson-Gutierrez Jr., PSY.D.
• Lashawnda Dimitra Anderson-Ide
• Lynn Anderson-Oppelt

• Vascular Surgery Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Vascular Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.