NPIMap

Individual provider Active NPI

Charles Raeburn Judy, M.D.

  • Family Medicine Physician
  • Radford, VA
National Provider Identifier
1720085392
Registry record updated Sep 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101050262 Issued in VA
Practice address
600 Randolph St
Radford, VA 24141-2428
Phone
(540) 639-5300
Fax
(540) 639-4653
NPI assigned
Jun 28, 2005
Last updated
Sep 27, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2011

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 0101050262 VA Primary

Addresses

Primary practice location

600 Randolph St
Radford, VA 24141-2428

Mailing address

600 Randolph St
Radford, VA 24141-2428
Phone (540) 639-5300

Other identifiers 2

IdentifierTypeStateIssuer
010172942MedicaidVA
5639719MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20050228000101 VA Practitioner - Family Practice 4183677552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Health Clinic, Inc.Group PAC ID 9032250469, 3 clinicians

Practice addresses (Care Compare)

600 Randolph St
Radford, VA 24141-2428
Phone (540) 639-5300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101050262VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Clinic, Inc. Family Medicine CurrentSince Jun 17, 1999 Accepting new patients
CRJ Physician Services Family Medicine PastSince Aug 17, 2004 Accepting new patients

Locations

600 Randolph St
Radford, VA 24141
Phone (540) 639-5300

Interoperability endpoints

  • Direct secure messaging: charlesjudy@fhci.allscriptsdirect.net

Organizations & group practices 2

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 7

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1720085392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 RANDOLPH ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241412428",
            "telephone_number": "540-639-5300",
            "fax_number": "540-639-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 RANDOLPH ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241412428",
            "telephone_number": "540-639-5300",
            "fax_number": "540-639-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDY",
        "first_name": "CHARLES",
        "middle_name": "RAEBURN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101050262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010172942",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5639719",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Radford, VA

Sources for this page

Verify at the official NPI Registry.