Charles Robert McCormick, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G35177 Issued in CA

Practice address

1240 W Robinhood Dr
Suite G
Stockton, CA 95207-5507

Phone

(209) 472-1470

Fax

(209) 472-1961

NPI assigned

Jun 26, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Hill Physicians Care Solutions, Inc.

  • Health Maintenance Organization
  • San Ramon, CA
  • NPI 1437769429
  NPD (past)
• Hill Physicians Medical Group - PPO Program

  • Preferred Provider Organization
  • San Ramon, CA
  • NPI 1679011035
  NPD (past)
• Service First of Northern California

  • Physical Therapist
  • Stockton, CA
  • NPI 1689880809
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1851328991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 W ROBINHOOD DR",
            "address_2": "SUITE G",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075507",
            "telephone_number": "209-472-1470",
            "fax_number": "209-472-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 W ROBINHOOD DR",
            "address_2": "SUITE G",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075507",
            "telephone_number": "209-472-1470",
            "fax_number": "209-472-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "CHARLES",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G35177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "G35177",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "721556520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosemarie A McCloud
• Darrell McCollough Jr.
• Maya Nicole McCord
• Anthony R McCormack
• Brianna Faye McCormick-Winger
• Whitney McCormick
• Lee William McCowan Sr.
• Amber McCoy
• Petra McCoy
• Stephanie McCoy, ACSW

• Pediatrics Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.