NPIMap

Individual provider Active NPI

Charles Kelley Tibbels, MD

  • Family Medicine Physician
  • Decatur, TX
National Provider Identifier
1871569632
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E6655 Issued in TX
Practice address
1821 S FM 51
Decatur, TX 76234-3715
Phone
(940) 233-6929
Fax
(877) 892-4569
NPI assigned
Feb 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E6655 TX Primary

Addresses

Primary practice location

1821 S FM 51
Decatur, TX 76234-3715

Mailing address

1821 S FM 51
Decatur, TX 76234-3715
Phone (940) 233-6929

Other identifiers 5

IdentifierTypeStateIssuer
080094585OtherTXRAILROAD MEDICARE
136230301MedicaidTX
8EG149OtherTXBCBSTX
136230311MedicaidTX
P00362520OtherTXRAILROAD MEDICARE-AMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20050411000514 TX Practitioner - Family Practice 9234176314 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E6655TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jack County Hospital District Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
Wise Clinical Care Associates Family Medicine CurrentSince Mar 24, 2014 Accepting new patients
Decatur Hospital Authority Current Accepting new patients
Jack County Hospital District CurrentSince Jan 1, 2020 Accepting new patients
West Wharton County Hospital District Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients
Decatur Hospital Authority Past Accepting new patients
Decatur Hospital Authority Past Accepting new patients
Decatur II Enterprises, L.L.C. Past Accepting new patients
Jack County Hospital District Past Accepting new patients

Locations

115 E Bypass 287
Alvord, TX 76225
Phone (940) 427-2858

115 E Bypass 287
Ste A
Alvord, TX 76225
Phone (940) 427-2858

133 N FM 730
Unit 105
Boyd, TX 76023
Phone (940) 433-2151

1821 S FM 51
Ste A
Decatur, TX 76234

2301 S FM 51
Ste 100
Decatur, TX 76234
Phone (817) 674-7494

2000 S FM 51
Decatur, TX 76234
Phone (940) 626-1848

2014 Ben Merritt Dr
Ste B
Decatur, TX 76234
Phone (940) 626-2962

1821 S FM 51
Decatur, TX 76234
Phone (855) 277-2979

215 Chisholm Trl
Jacksboro, TX 76458
Phone (940) 567-5528

Interoperability endpoints

  • Direct secure messaging: charles.tibbels.1@11284.direct.athenahealth.com
  • Direct secure messaging: charles.kelley.tibbels.1@31575.direct.athenahealth.com
  • Direct secure messaging: charlestibbels@wise.allscriptsdirect.net

Organizations & group practices 12

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 9

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

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at Houston, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Array Provider Associates, PA 2 clinicians
Jack County Hospital District 20 clinicians

Practice addresses (Care Compare)

1821 S FM
Suite 51
Decatur, TX 76234-3715
Phone (940) 233-6929

215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633

Hospital & facility affiliations

  • Angels Care Home Health Home health agency, Decatur, TX, CCN 457786
  • Solaris Home Health Home health agency, Decatur, TX, CCN 747398
  • Solaris Hospice Inc Hospice, Decatur, TX, CCN 451688
  • Concho Hearts Hospice, LLC Hospice, San Angelo, TX, CCN 971627
  • Medical City Denton Hospital, Denton, TX, CCN 450634
  • Heritage Place of Decatur Nursing home, Decatur, TX, CCN 675513
  • Bridgeport Medical Lodge Nursing home, Bridgeport, TX, CCN 675891
  • Decatur Medical Lodge Nursing home, Decatur, TX, CCN 676209
  • The Hills Nursing & Rehabilitation Nursing home, Decatur, TX, CCN 676004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions27
Removal or shaving of skin growth1-10
Skin biopsy11

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1871569632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 S FM 51",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343715",
            "telephone_number": "940-233-6929",
            "fax_number": "877-892-4569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 S FM 51",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343715",
            "telephone_number": "940-233-6929",
            "fax_number": "877-892-4569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBELS",
        "first_name": "CHARLES",
        "middle_name": "KELLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E6655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080094585",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136230301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8EG149",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136230311",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE-AMC",
            "identifier": "P00362520",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, TX

Sources for this page

Verify at the official NPI Registry.