Individual provider Active NPI

Charles R Heron, M.D.

  • Anesthesiology Physician
  • Effingham, IL
National Provider Identifier
1942283585
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036-128867 Issued in IL
Practice address
904 W Temple Ave
Effingham, IL 62401
Phone
(217) 342-1234
Fax
(217) 342-1230
NPI assigned
Nov 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 33270-020 WI
Anesthesiology Physician 207L00000X 036-128867 IL Primary

Addresses

Primary practice location

904 W Temple Ave
Effingham, IL 62401

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other identifiers 2

IdentifierTypeStateIssuer
32081000MedicaidWI
P0036797OtherRAIL ROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20111118000517 IL Practitioner - Anesthesiology 6204836703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Michigan State University College of Human Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

904 W Temple Ave
Effingham, IL 62401-2178
Phone (217) 342-1234

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-128867ILMDAnesthesiology Physician
33270-020WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Dec 1, 2024 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Dec 1, 2024 Accepting new patients
Millenium Anesthesiologists, LTD. Anesthesiology PastSince Oct 1, 2014 Accepting new patients

Locations

904 W Temple Ave
Effingham, IL 62401
Phone (217) 342-1234

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

Organizations & group practices 3

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 1

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": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1942283585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 W TEMPLE AVE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "62401",
            "telephone_number": "217-342-1234",
            "fax_number": "217-342-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERON",
        "first_name": "CHARLES",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "33270-020",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036-128867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32081000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P0036797",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.