Active NPI
Charles Owen McCormick III, M.D.
- Ophthalmology Physician
- Greenwood, IN
National Provider Identifier
1700879830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 01026314A
- Practice address
- 30 N Emerson Ave
Greenwood, IN 46143-8895 - Phone
- (317) 881-3937
- Fax
- (317) 887-4008
- NPI assigned
- Aug 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 01026314A | IN | Primary |
Addresses
Primary practice location
30 N Emerson Ave
Greenwood, IN 46143-8895
Mailing address
30 N Emerson Ave
Greenwood, IN 46143-8895
Phone (317) 881-3937
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000011606 | Other | IN | MPLAN |
| 352129520 | Other | IN | UNITED MINE WORKERS |
| 000000214798 | Other | IN | BCBS |
| 180044022 | Other | IN | RAILROAD MEDICARE |
| 100154690 | Medicaid | IN | |
| 000000011606 | Other | IN | SENIOR SMART CHOICE |
| 154727 | Other | IN | COLE VISION |
| AETNA | Other | IN | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01026314A | IN | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Ophthalmology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264982400000",
"number": "1700879830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 N EMERSON AVE",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461438895",
"telephone_number": "317-881-3937",
"fax_number": "317-887-4008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 N EMERSON AVE",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461438895",
"telephone_number": "317-881-3937",
"fax_number": "317-887-4008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "CHARLES",
"middle_name": "OWEN",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2010-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "01026314A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MPLAN",
"identifier": "000000011606",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED MINE WORKERS",
"identifier": "352129520",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000000214798",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "180044022",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100154690",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SENIOR SMART CHOICE",
"identifier": "000000011606",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLE VISION",
"identifier": "154727",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "AETNA",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.