NPIMap

Individual provider Active NPI

Charles E Brock Jr., M.D.

  • Family Medicine Physician
  • Cleveland, MS
National Provider Identifier
1689761280
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11341 Issued in MS
Practice address
810 E Sunflower Rd
Cleveland, MS 38732-2800
Phone
(662) 843-3606
NPI assigned
Oct 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 11341 MS Primary

Addresses

Primary practice location

810 E Sunflower Rd
Cleveland, MS 38732-2800

Mailing address

498 Hillcrest Cir
Cleveland, MS 38732-2008
Phone (662) 843-1433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20031205000114 MS Practitioner - Family Practice 9032014279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bolivar Physician Practices LLCGroup PAC ID 6305995895, 17 clinicians

Practice addresses (Care Compare)

810 E Sunflower Rd
Suite 100 a
Cleveland, MS 38732-2828
Phone (662) 843-3606

901 E Sunflower Rd
Cleveland, MS 38732-2833
Phone (662) 846-0061

905 E Sunflower Rd
Cleveland, MS 38732-2833
Phone (662) 843-5371

907 E Sunflower Rd
Cleveland, MS 38732-2830

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11341MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bolivar Physician Practices LLC Current Accepting new patients
Bolivar Physician Practices LLC CurrentSince Jan 1, 2015 Accepting new patients
Bolivar Physician Practices LLC CurrentSince Jan 1, 2015 Accepting new patients
Bolivar Physician Practices LLC Family Medicine Past Accepting new patients
Oak Circle Operating LLC Past Accepting new patients
PHC-Cleveland LLC Past Accepting new patients

Locations

907 E Sunflower Rd
Ste 102
Cleveland, MS 38732
Phone (662) 545-4443

Interoperability endpoints

  • Direct secure messaging: brock_jr_charles_f__md@yourcarecommunity.org
  • Direct secure messaging: charles.brock.1@10381.direct.athenahealth.com
  • Direct secure messaging: charles.brock.1@19392.direct.athenahealth.com

Organizations & group practices 6

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689761280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 HILLCREST CIR",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322008",
            "telephone_number": "662-843-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E SUNFLOWER RD",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322800",
            "telephone_number": "662-843-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "11341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, MS

Sources for this page

Verify at the official NPI Registry.