Charles M Nieto, M.D.
Individual provider Active NPI Internal Medicine Physician · Ridgeville, SC
NPI 1992785653 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1992785653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 218850 (NY)
- Practice address
- 4789 State Rd
Ridgeville, SC 29472-6921 - Phone
- (843) 688-5311
- NPI assigned
- Jan 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050718000512 | TX | Practitioner - Family Practice |
3678530045 | Reassigns benefits to 1 organization |
| I20230411000596 | NY | Practitioner - Internal Medicine | 3678530045 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hudson Valley Radiology Associates PLLC | Current |
Accepting new patients | |
| Hospitalists of Pueblo | Past | Accepting new patients |
Locations
27443 Network Pl
Chicago, IL 60673
18 Squadron Blvd
New City, NY 10956
Phone (845) 368-3002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | DR44149 | CO | |
| Internal Medicine Physician | 207R00000X | 218850 | NY | Yes |
Addresses
Primary practice location
4789 State Rd
Ridgeville, SC 29472-6921
Mailing address
2960 Tongass Ave
Ketchikan, AK 99901-5742
Phone (907) 228-4900
Other practice location 1
1360 S Potomac St
Aurora, CO 80012-4505
Phone (303) 337-5575
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44929064 | Medicaid | CO |
Other providers in Ridgeville, SC
- Wayne R Macintosh
- Jan Macleay
- Tatreka Polite Middleton
- Renee E Mitchell
- Sarina Mallory Muckelvaney
- Emily Murdaugh Noble
- Rebekah Norris
- Palmetto Respiratory,LLC
- Refreshed Total Wellness
- Elizabeth Anne Ringold
All providers in Ridgeville, SC · Internal Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.