NPIMap

Individual provider Active NPI

Charles Haviland Mize, M.D.

  • Emergency Medicine Physician
  • Bridgeport, CT
National Provider Identifier
1689834012
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
D0072287 Issued in MD
Practice address
267 Grant St
Bridgeport, CT 06610-2805
Phone
(203) 384-3256
NPI assigned
Jun 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X D0072287 MD Primary

Addresses

Primary practice location

267 Grant St
Bridgeport, CT 06610-2805

Mailing address

27 Halls Point Rd
Branford, CT 06405-5704

Other names 1

  • Dr. Charles Haviland Moore Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, VI, AK, CA4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20140501001003 CT Practitioner - Emergency Medicine 0941479034 Reassigns benefits to 1 organization
I20210304001119 VI Practitioner - Emergency Medicine 0941479034 Reassigns benefits to 1 organization
I20241113004069 AK Practitioner - Emergency Medicine 0941479034 Reassigns benefits to 2 organizations
I20260324001481 CA Practitioner - Emergency Medicine 0941479034 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Columbia University College of Physicians and Surgeons, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of SewardGroup PAC ID 2466362280, shared by 4 NPIs, 18 clinicians
La Jolla Emergency SpecialistsGroup PAC ID 1153552039, 18 clinicians

Practice addresses (Care Compare)

417 1St Ave
Seward, AK 99664-0365
Phone (907) 224-5205

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-6150

Hospital & facility affiliations

  • Scripps Memorial Hospital la Jolla Hospital, La Jolla, CA, CCN 050324
  • Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010
  • Providence Seward Hospital Hospital, Seward, AK, CCN 021302

Merit-based Incentive Payment System (MIPS)

Final score
96.02 of 100Reported as group
Quality
87.5
Promoting interoperability
100
Improvement activities
40
Cost
77.51

Merit-based Incentive Payment System (MIPS)

Final score
93 of 100Reported as group
Quality
62.16
Promoting interoperability
100
Improvement activities
40
Cost
100

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Apr 5, 2021 Accepting new patients
City of Seward Emergency Medicine Current Accepting new patients
City of Seward CurrentSince Nov 9, 2024 Accepting new patients
City of Seward CurrentSince Jan 1, 2026 Accepting new patients
Governor Juan F. Luis Hospital & Medical Center CurrentSince Apr 5, 2021 Accepting new patients
City of Seward CurrentSince Nov 9, 2024 Accepting new patients

Locations

4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423

Interoperability endpoints

  • Direct secure messaging: cmize123666@direct.ynhh.org

Organizations & group practices 9

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.

Hospital & facility affiliations 4

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": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1689834012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 HALLS POINT RD",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064055704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZE",
        "first_name": "CHARLES",
        "middle_name": "HAVILAND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0072287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLES",
            "last_name": "MOORE",
            "middle_name": "HAVILAND",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.