Charles Emmet Stout Jr., MD, PHD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

A100577 Issued in CA

Practice address

4445 Magnolia Ave
Riverside, CA 92501-4135

Phone

(951) 338-4910

Fax

(833) 996-0004

NPI assigned

Jun 29, 2007

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 CA

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

Diagnostic RadiologyAlso: Interventional Radiology

Education

Loma Linda University School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

California Neurointerventional Surgeons, IncGroup PAC ID 2668717125, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside Community Hospital Hospital, Riverside, CA, CCN 050022
• Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292
• Parkview Community Hospital Medical Center Hospital, Riverside, CA, CCN 050102

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cstout509946@direct.llu.edu

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.

• California Neurointerventional Surgeons, Inc

  • Vascular & Interventional Radiology Physician
  • Riverside, CA
  • NPI 1417315300
  Medicare reassignment Care Compare group NPD Authorized official
• Neurovascular Medical Group, Inc

  • Specialist
  • San Francisco, CA
  • NPI 1730126103
  NPD (past)

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

• County of Riverside

  • General Acute Care Hospital
  • Moreno Valley, CA
  • NPI 1821159195
  Care Compare affiliation
• Doctors Hospital of Riverside LLC

  • General Acute Care Hospital
  • Riverside, CA
  • NPI 1124596382
  Care Compare affiliation
• Riverside Healthcare System, L.P.

  • General Acute Care Hospital
  • Riverside, CA
  • NPI 1114971660
  Care Compare affiliation

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1679770994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E REDLANDS BLVD # 714",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736109",
            "telephone_number": "951-338-4910",
            "fax_number": "833-996-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014135",
            "telephone_number": "951-338-4910",
            "fax_number": "833-996-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "CHARLES",
        "middle_name": "EMMET",
        "name_suffix": "Jr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "A100577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Storm
• Stormbreaker Wellness, Inc.
• Kayla Lorraine Stormer
• Keith D Stottlemyer, MD
• Benton Real Stout, PHYSICIAN ASSISTANT
• Cynthia Stover, P.A.
• Anthony Michael Strada, MD
• Strategic Medical Partners a Professional Corp
• James Strawn, L.C.S.W.
• Latoria Street, BCAT

• Vascular & Interventional Radiology Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Vascular & Interventional Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.