NPIMap

Individual provider Active NPI

Charles S. Krin, D.O.

  • Emergency Medicine Physician
  • Poplar Bluff, MO
National Provider Identifier
1780625384
Registry record updated Jul 8, 2007
On this page

OIG exclusion record

The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:

  • Section 1128b(4) exclusion effective Jul 20, 2011.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2005035774 Issued in MO
Practice address
2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone
(573) 785-7721
NPI assigned
Jun 8, 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
Emergency Medicine Physician 207P00000X 2005035774 MO Primary

Addresses

Primary practice location

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396

Mailing address

4425 Ridge Dr
High Ridge, MO 63049-1906

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidMO

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)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
TH Contracting Services of Missouri Emergency Medicine Past Accepting new patients
Correct Care, Inc. Emergency Medicine Past Accepting new patients
LGH Oncology Clinic Past Accepting new patients
United Emergency Services, Inc. Emergency Medicine Past Accepting new patients
Cenla Chiropractic & Wellness Past Accepting new patients
Nes Louisiana Inc Emergency Medicine Past Accepting new patients
Kennett Emergency Physicians Emergency Medicine Past Accepting new patients
Missouri Em-I Medical Services, PC Past Accepting new patients
Inphynet Primary Care Physicians Southeast PC Emergency Medicine Past Accepting new patients
Callaway Emergency Physicians, LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780625384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 RIDGE DR",
            "city": "HIGH RIDGE",
            "state": "MO",
            "postal_code": "630491906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013396",
            "telephone_number": "573-785-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRIN",
        "first_name": "CHARLES",
        "middle_name": "S.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2005035774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.