Charles A. Shoultz III, M.D.

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

License

J6243 Issued in TX

Practice address

7125 New Sanger Ave Ste a
Waco, TX 76712-4054

Phone

(254) 399-5400

Fax

(254) 772-8669

NPI assigned

Jun 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 9

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional Cardiology

Education

University of Texas Medical School at Houston, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Waco Cardiology AssociatesGroup PAC ID 2860464948, 22 clinicians

Cardiac Cath Lab of Waco LPGroup PAC ID 7113189473, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Providence Hospital, Waco, TX, CCN 450042
• Hamilton General Hospital Hospital, Hamilton, TX, CCN 451392
• Baylor Scott & White Medical Center Hillcrest Hospital, Waco, TX, CCN 450101
• Limestone Medical Center Hospital, Groesbeck, TX, CCN 451303
• Goodall Witcher Hospital Hospital, Clifton, TX, CCN 451385

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: charles.shoultz.p1@direct.wacocardiology.nextgenshare.com

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.

• Cardiac Cath Lab of Waco LP

  • Multi-Specialty Clinic/Center
  • Waco, TX
  • NPI 1285914291
  Medicare reassignment Care Compare group NPD
• Waco Cardiology Associates

  • Cardiovascular Disease Physician
  • Waco, TX
  • NPI 1982607735
  Medicare reassignment Care Compare group NPD
• Hendrick Provider Network

  • Internal Medicine Physician
  • Abilene, TX
  • NPI 1396961322

  Interventional Cardiology

  Medicare reassignment NPD
• Hendrick Provider Network

  • Rural Health Clinic/Center
  • San Saba, TX
  • NPI 1346044401
  NPD

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

• Ascension Providence

  • General Acute Care Hospital
  • Waco, TX
  • NPI 1093708679
  Care Compare affiliation
• Bosque County Hospital District

  • Critical Access Hospital
  • Clifton, TX
  • NPI 1104383371
  Care Compare affiliation
• Hamilton County Hospital District

  • Critical Access Hospital
  • Hamilton, TX
  • NPI 1326037607
  Care Compare affiliation
• Hillcrest Baptist Medical Center

  • General Acute Care Hospital
  • Waco, TX
  • NPI 1891882833
  Care Compare affiliation
• South Limestone Hospital District

  • Critical Access Hospital
  • Groesbeck, TX
  • NPI 1861487779
  Care Compare affiliation

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699574400000",
    "number": "1780680496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21327",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767021327",
            "telephone_number": "254-399-5400",
            "fax_number": "254-772-8669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7125 NEW SANGER AVE STE A",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767124054",
            "telephone_number": "254-399-5400",
            "fax_number": "254-772-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOULTZ",
        "first_name": "CHARLES",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "J6243",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TX",
            "license": "J6243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "100345101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTHEALTH",
            "identifier": "1221938",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "142799902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117613302",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SWHP",
            "identifier": "90032",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "74178408876712A004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117613301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4559831",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "83W040",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charles.shoultz.p1@direct.wacocardiology.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "API for Waco Cardiology Associates",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "wacocardiology@direct.wacocardiology.nextgenshare.com",
            "address_1": "7125 New Sanger Ave Ste A",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767124054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James Norman Shinder, PH. D., M.P.H.
• Ross Franklin Shipp, MD
• Judy Kay Shofner, LPC
• Hannah Short, LCSW
• Helen Ann Short, M.D.
• Rebecca L Shumake
• Bryce C Shutt, M.D.
• Aman Sibal, M.D.
• Lynea Sibley, OTR
• Alexandra Siedlecki

• Interventional Cardiology Physician in Waco, TX
• Providers in Waco, TX by specialty
• Interventional Cardiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.