NPIMap

Individual provider Active NPI

Charles Girard Tisdale, PA-C

  • Surgical Physician Assistant
  • Shreveport, LA
National Provider Identifier
1821096686
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA.A10284 Issued in LA
Practice address
1500 Line Ave Ste 100
Shreveport, LA 71101-4644
Phone
(318) 635-3052
NPI assigned
Jul 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X A10284 LA
Surgical Physician Assistant 363AS0400X PA.A10284 LA Primary

Addresses

Primary practice location

1500 Line Ave Ste 100
Shreveport, LA 71101-4644

Mailing address

1500 Line Ave Ste 100
Shreveport, LA 71101-4644
Phone (318) 635-3052

Other identifiers 1

IdentifierTypeStateIssuer
1626708MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address charles.tisdale.p1@direct.hcapmc.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20090804000005 LA Practitioner - Physician Assistant 9638266562 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid State Orthopaedic and Sports Medicine Center LLCGroup PAC ID 6204892540, 27 clinicians

Practice addresses (Care Compare)

1500 Line Ave
Suite 100
Shreveport, LA 71101-4644
Phone (318) 635-3052

3444 Masonic Dr
Alexandria, LA 71301-3615
Phone 31844183291329

429 Rocky Bayou Dr
Suite a
Pineville, LA 71360-8133
Phone 31847395561329

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.38 of 100Reported as group
Quality
87.5
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Musculoskeletal Institute of Louisiana, L.L.C. Physician Assistant CurrentSince Oct 6, 2022 Accepting new patients
Highland Clinic, a Prof Med Corp CurrentSince Jun 20, 2016 Accepting new patients
Highland Clinic, a Prof Med Corp CurrentSince Jun 20, 2016 Accepting new patients
Mid State Orthopaedic & Sports Medicine Center LLC CurrentSince Oct 20, 2025 Accepting new patients
Christus Health Central Louisiana Past Accepting new patients
Lsuhn Billing LLC Past Accepting new patients

Locations

3444 Masonic Dr
Alexandria, LA 71301
Phone (318) 441-8329

3351 Masonic Dr
Alexandria, LA 71301
Phone (318) 448-6800

2005 Landry Dr
Bossier City, LA 71111
Phone (318) 752-7850

429 Rocky Bayou Dr
Ste A
Pineville, LA 71360
Phone (318) 473-9556

429 Rocky Bayou Dr
Pineville, LA 71360
Phone (318) 473-9556

429 Rocky Bayou Dr
Ste B
Pineville, LA 71360

1455 E Bert Kouns Industrial Loop
#210
Shreveport, LA 71105
Phone (318) 798-4623

1534 Elizabeth Ave
Ste 301
Shreveport, LA 71101
Phone (318) 629-5002

1500 Line Ave
Ste 200
Shreveport, LA 71101
Phone (318) 629-5555

1500 Line Ave
Ste 100
Shreveport, LA 71101
Phone (318) 635-3052

1455 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 300-3643

Interoperability endpoints

  • Direct secure messaging: charles.tisdalepac.p1@direct.msil.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: charles.tisdale.p1@direct.hcapmc.nextgenshare.com
  • Direct secure messaging: ctisdale@midstateortho.emadirect.md

Organizations & group practices 7

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.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1821096686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 LINE AVE STE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014644",
            "telephone_number": "318-635-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LINE AVE STE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014644",
            "telephone_number": "318-635-3052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "CHARLES",
        "middle_name": "GIRARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "A10284",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "PA.A10284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1626708",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charles.tisdale.p1@direct.hcapmc.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1455 E Bert Koun Loop",
            "address_2": "#210",
            "city": "Shreveport",
            "state": "LA",
            "country_code": "US",
            "postal_code": "711055634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.