Charles Manley Clodfelter Jr., MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME0071159 Issued in FL

Practice address

701 W Cocoa Beach Cswy
Cocoa Beach, FL 32931-3585

Phone

(321) 799-7111

NPI assigned

Jan 13, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

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.

• Brevard Physician Associates, PLLC

  • Anesthesiology Physician
  • Melbourne, FL
  • NPI 1598008955

  Emergency Medicine, FL

  Medicare reassignment NPD
• Northport Emergency Associates, PA

  • Emergency Medical Services (Emergency Medicine) Physician
  • North Port, FL
  • NPI 1881835569
  NPD (past)
• Sarasota Emergency Associates PA

  • Emergency Medicine Physician
  • Sarasota, FL
  • NPI 1831175306

  Emergency Medicine

  NPD (past)
• Space Coast Emergency Physicians PLC

  • Emergency Medicine Physician
  • Cocoa Beach, FL
  • NPI 1508851569

  Emergency Medicine

  NPD (past)
• West Orange Healthcare Inc

  • Emergency Medicine Physician
  • Ocoee, FL
  • NPI 1720073737

  Emergency Medicine

  NPD (past)

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410393600000",
    "number": "1891774188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2400",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329022400",
            "telephone_number": "321-837-3820",
            "fax_number": "321-837-3654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W COCOA BEACH CSWY",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329313585",
            "telephone_number": "321-799-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLODFELTER",
        "first_name": "CHARLES",
        "middle_name": "MANLEY",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2014-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME0071159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250653000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "32302",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jose Andres Chavac Rodas, APRN
• David Che, D.D.S
• Yuan Chen
• Fadila L Clarisse, LMT
• Kelly-Michelle Clark Satcher, EDD
• Cocoa Beach Discount Pharmacy LLC
• Cocoa Beach Discount Pharmacy LLC
• Cocoa Beach Family Medicine
• Cocoa Beach Hearing Center
• Kerri Lynn Connell, PA-C

• All providers in Cocoa Beach, FL
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; 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.