Active NPI
Charles Thompson, MD
- Pediatrics Physician
- Ave Maria, FL
National Provider Identifier
1932175015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME137399
- Practice address
- 5178 Milano St
Ave Maria, FL 34142-9548 - Phone
- (860) 460-7195
- Fax
- (860) 460-7195
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 039780 | CT | |
| Pediatrics Physician | 208000000X | ME137399 | FL | Primary |
Addresses
Primary practice location
5178 Milano St
Ave Maria, FL 34142-9548
Mailing address
5178 Milano St
Ave Maria, FL 34142-9548
Phone (860) 460-7195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001397802 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039780 | CT | MD | Pediatrics Physician |
| ME137399 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710028800000",
"number": "1932175015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5178 MILANO ST",
"city": "AVE MARIA",
"state": "FL",
"postal_code": "341429548",
"telephone_number": "860-460-7195",
"fax_number": "860-460-7195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5178 MILANO ST",
"city": "AVE MARIA",
"state": "FL",
"postal_code": "341429548",
"telephone_number": "860-460-7195",
"fax_number": "860-460-7195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "CHARLES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2024-03-10",
"certification_date": "2024-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "039780",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME137399",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001397802",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ave Maria, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.