Charles Jay Bawcom, APRN-RNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

241530 Issued in AZ

Practice address

1 Clinic Rd # 369
Grand Canyon, AZ 86023-0290

Phone

(928) 638-2551

Fax

(928) 638-2598

NPI assigned

May 26, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ, NM2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Associates of Northern New MexicoGroup PAC ID 1557354339, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Los Alamos Medical Center Hospital, Los Alamos, NM, CCN 320033

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Medical Associates of Northern New Mexico

  • Cardiovascular Disease Physician
  • Los Alamos, NM
  • NPI 1073501508
  Medicare reassignment Care Compare group
• El Rio Santa Cruz Neighborhood Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Tucson, AZ
  • NPI 1487602736
  Medicare reassignment
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1073583472
  NPD
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Show Low, AZ
  • NPI 1073740098
  NPD
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Winslow, AZ
  • NPI 1275657363
  NPD
• North Country Healthcare, Inc.

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1619345675
  NPD
• North Country Healthcare, Inc.

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1669911764
  NPD (past)
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1821228826
  NPD (past)

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

• PHC-Los Alamos Inc

  • Rural Acute Care Hospital
  • Los Alamos, NM
  • NPI 1285701623
  Care Compare affiliation

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

{
    "created_epoch": "1590451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1801419841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1231",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857021231",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CLINIC RD # 369",
            "city": "GRAND CANYON",
            "state": "AZ",
            "postal_code": "860230290",
            "telephone_number": "928-638-2551",
            "fax_number": "928-638-2598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAWCOM",
        "first_name": "CHARLES",
        "middle_name": "JAY",
        "name_prefix": "Mr.",
        "credential": "APRN-RNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-26",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "241530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Avantyr, LMT
• Krystal D Carey, FNP
• Traci Raene Curley, ATS
• El Rio Santa Cruz Neighborhood Health Center Inc
• El Rio Santa Cruz Neighborhood Health Center Inc
• Elk Ridge Grand Canyon Pharmacy

• Family Nurse Practitioner in Grand Canyon, AZ
• Providers in Grand Canyon, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; 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.