NPIMap

Individual provider Active NPI

Charles Christopher Walcott, D.O.

  • Family Medicine Physician
  • Johnson City, NY
National Provider Identifier
1790043446
Registry record updated Aug 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
054219 Issued in CT
Practice address
40 Arch St
Johnson City, NY 13790-2102
Phone
(607) 763-6075
Fax
(607) 763-5234
NPI assigned
May 1, 2012
Last updated
Aug 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 054219 CT Primary

Addresses

Primary practice location

40 Arch St
Johnson City, NY 13790-2102

Mailing address

346 Grand Ave
Johnson City, NY 13790-2580
Phone (607) 763-6075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20150923000372 CT Practitioner - Family Practice 5092946764 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

248 Flanders Rd
Niantic, CT 06357-1264
Phone (860) 739-5426

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue78
Removal of skin lesions22
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
054219CTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Afc Physicians of Connecticut, PC Current Accepting new patients
Northeast Medical Group, Inc. CurrentSince Apr 1, 2017 Accepting new patients
Afc Physicians of Connecticut, PC CurrentSince Oct 1, 2016 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Apr 1, 2017 Accepting new patients
Afc Physicians of Connecticut, PC CurrentSince Oct 1, 2016 Accepting new patients
United Health Services Hospitals, Inc. Past Accepting new patients

Locations

226 Mill Hill Ave
Ste 3
Bridgeport, CT 06610
Phone (203) 384-3394

2 Main St
Danbury, CT 06810
Phone (203) 826-2140

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

248 Flanders Rd
Niantic, CT 06357
Phone (860) 739-5426

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

40 Boston Post Rd
Waterford, CT 06385
Phone (860) 271-4900

1030 Boulevard
West Hartford, CT 06119
Phone (860) 986-6440

Interoperability endpoints

  • Direct secure messaging: cwalcott329557@direct.ynhh.org

Organizations & group practices 6

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 8

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": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440115200000",
    "number": "1790043446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 GRAND AVE",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902580",
            "telephone_number": "607-763-6075",
            "fax_number": "607-763-5234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 ARCH ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902102",
            "telephone_number": "607-763-6075",
            "fax_number": "607-763-5234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALCOTT",
        "first_name": "CHARLES",
        "middle_name": "CHRISTOPHER",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2015-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "054219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.