Individual provider Active NPI

Charles Benjamin Palmer IV, D.O.

  • Gynecologic Oncology Physician
  • Louisville, KY
National Provider Identifier
1801090626
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
04495 Issued in KY
Practice address
10200 Forest Green Blvd Ste 112
Louisville, KY 40223-5167
Phone
(877) 866-7123
NPI assigned
Jun 14, 2007
Last updated
Sep 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 2011-00750 NC
Obstetrics & Gynecology Physician 207V00000X OS018028 PA
Gynecologic Oncology Physician 207VX0201X 04495 KY Primary

Addresses

Primary practice location

10200 Forest Green Blvd Ste 112
Louisville, KY 40223-5167

Mailing address

PO Box 776347
Chicago, IL 60677-6347
Phone (502) 272-5052

Other practice location 1

35 Monument Rd
Suite 206
York, PA 17403-5074
Phone (717) 851-6120

Other practice location 2

315 E Broadway Fl 4
Louisville, KY 40202
Phone (502) 629-2500

Electronic endpoints 3

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark
Direct Messaging Address cpalmer163849@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190807001579 KY Practitioner - Obstetrics/Gynecology 3173791167 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10200 Forest Green Blvd
Suite 112
Louisville, KY 40223-5167
Phone (954) 399-4673

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue614
Removal of skin lesions35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS018028PAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vohra Post Acute Care Physicians of the East, PA Family Medicine CurrentSince Mar 8, 2021 Accepting new patients
Norton Hospitals Inc CurrentSince Aug 1, 2019 Accepting new patients
Norton Hospitals, Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

10200 Forest Green Blvd
Ste 112
Louisville, KY 40223
Phone (502) 214-5343

315 E Broadway
Louisville, KY 40202
Phone (502) 272-5331

315 E Broadway
Fl 4
Louisville, KY 40202
Phone (502) 272-5165

8400 Normandale Lake Blvd
Ste 920
Minneapolis, MN 55437
Phone (612) 735-4509

40 Sunset Ridge Rd
Ste 120
New Paltz, NY 12561

Interoperability endpoints

  • Direct secure messaging: cpalmer163849@direct.nortonhealthcare.org

Organizations & group practices 3

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1801090626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776347",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776347",
            "telephone_number": "502-272-5052",
            "fax_number": "502-629-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 FOREST GREEN BLVD STE 112",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235167",
            "telephone_number": "877-866-7123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35 Monument Rd",
            "address_2": "Suite 206",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174035074",
            "country_code": "US",
            "telephone_number": "717-851-6120",
            "fax_number": "717-851-6129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 E Broadway Fl 4",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40202",
            "country_code": "US",
            "telephone_number": "502-629-2500",
            "fax_number": "502-629-2055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMER",
        "first_name": "CHARLES",
        "middle_name": "BENJAMIN",
        "name_suffix": "IV",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "2011-00750",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "OS018028",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "KY",
            "license": "04495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cpalmer163849@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "315 E Broadway Fl 4",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "40202",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "315 E Broadway Fl 4",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "40202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.