Charles Ray Alderdice, D.O.
Individual provider Active NPI Family Medicine Physician · Saint Joseph, MI
NPI 1821056649 · NPPES record last updated Jul 1, 2010
Key facts
- NPI
- 1821056649
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101008526 (MI)
- Practice address
- 1906 Langley Ave
Saint Joseph, MI 49085-1739 - Phone
- (269) 982-1722
- Fax
- (269) 982-1842
- NPI assigned
- May 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110307000600 | MI | Practitioner - Family Practice |
7810179231 | Practice locations: Saint Joseph, MI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C R Alderdice D O | Family Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101008526 | MI | Yes |
Addresses
Primary practice location
1906 Langley Ave
Saint Joseph, MI 49085-1739
Mailing address
1906 Langley Ave
Saint Joseph, MI 49085-1739
Phone (269) 982-1722
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015110022 | Other | MI | BS |
| 1607063 | Medicaid | MI | |
| 010012749 | Other | MI | MRRR |
| 134870500 | Other | MI | USDEP |
| 382531804 | Other | MI | TRICA |
Other providers in Saint Joseph, MI
- Advanced Mobile Eye Care, LLC
- Advanced Skin and Mohs Surgery Clinics, P.C.
- Aging Fit, Inc.
- Mahrukh Fatima Akram
- Majdi Suleiman Al-Najjar
- Kristina Aleksoniene
- Sydney Alexander
- Nasam Alfraji
- Alimenti Family Medicine
- Sigita Alimenti
All providers in Saint Joseph, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.