NPIMap

Individual provider Active NPI

Jackson Charles Pugh, M.D.

  • Family Medicine Physician
  • Perryville, MO
National Provider Identifier
1912345935
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2020024607 Issued in MO
Practice address
434 N West St
Perryville, MO 63775-1359
Phone
(573) 547-2536
NPI assigned
Jun 12, 2013
Last updated
Jul 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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 2020024607 MO Primary

Addresses

Primary practice location

434 N West St
Perryville, MO 63775-1359

Mailing address

434 N West St
Perryville, MO 63775-1359
Phone (573) 547-2536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20201007001748 MO Practitioner - Family Practice 5496057960 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians of Memphis LLCGroup PAC ID 5395643209, 92 clinicians

Practice addresses (Care Compare)

7245 Raider Rd
Bonne Terre, MO 63628-3767
Phone (573) 358-1400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry Emergency Medicine CurrentSince Jul 14, 2025 Accepting new patients
Southeastern Emergency Physicians of Memphis LLC Emergency Medicine CurrentSince Jun 1, 2021 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince May 13, 2022 Accepting new patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Mercy Hospital Perry Family Medicine CurrentSince Jul 14, 2025 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince May 13, 2022 Accepting new patients
Mercy Clinic East Communities Family Medicine PastSince Sep 1, 2020 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

7245 Raider Rd
Bonne Terre, MO 63628
Phone (573) 358-1400

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1101 W Liberty St
Farmington, MO 63640
Phone (573) 705-1272

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

6420 Clayton Rd
Rm 2234
Saint Louis, MO 63117
Phone (314) 951-7230

500 Medical Dr
Wentzville, MO 63385
Phone (636) 327-1000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1912345935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 N WEST ST",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751359",
            "telephone_number": "573-547-2536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 N WEST ST",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751359",
            "telephone_number": "573-547-2536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGH",
        "first_name": "JACKSON",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2020024607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perryville, MO

Sources for this page

Verify at the official NPI Registry.