CHARLES K. BOLEY (NPI# 1912126640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912126640 |
| Entity Type | Individual |
| Full Name | CHARLES K. BOLEY |
| Practice Address |
10 Saint Clare Ct Ste 100 Washington IL 61571-9239 |
| Practice Telephone | 3098864000 |
| Practice Fax Number | 3098864118 |
| Mailing Telephone | 3098864000 |
| Mailing Fax Number | 3098864118 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-06-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 036-115574 | IL | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 036-115574 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RR MEDICARE | P00401636 | 01 | |
| 833230 - PONTIAC GROUP # | 833230 | 01 | |
| IL | 036115574 | 05 | |
| RR GROUP | CA4079 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114958857 | Charles Richard Boley II | Chiropractor | 1895 E Roseville Pkwy, Suite 170, Roseville, CA 95661-7976 | 2006-07-05 |
| Street Address |
10 SAINT CLARE CT STE 100 |
| City | WASHINGTON |
| State | IL |
| Zip Code | 61571-9239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669422333 | Anthony John Cutinello Jr. | Family Medicine | 10 Saint Clare Ct Ste 100, Washington, IL 61571-9239 | 2006-05-11 |
| 1730686015 | Kayla Zimmerman | Nurse Practitioner | 10 Saint Clare Ct Ste 100, Washington, IL 61571-9239 | 2018-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904504 | Kelly Hornberger | Physical Therapist | 1201 Newcastle Rd., Washington, IL 61571 | 2018-09-01 |
| 1073050407 | Jillyn Cross | Occupational Therapist | 14 Oxford Court, Washington, IL 61571 | 2017-01-24 |
| 1639410772 | Stephen L Dejaynes | Counselor | 100 Hillcrest Drive, Washington, IL 61571 | 2013-03-14 |
| 1184998692 | One Counseling and Wellness | Counselor | 1003 North Cummings Lane, Washington, IL 61571 | 2012-03-01 |
| 1871878371 | M Lisa Kim | Pharmacist | 1700 Saddleridge Ct, Washington, IL 61571 | 2011-10-15 |
| 1073805156 | Skill Sprout International | Behavioral Analyst | 102 Walnut Street, Washington, IL 61571 | 2011-05-09 |
| 1659600948 | Skill Sprout, LLC | Behavioral Analyst | 128 Washington Square, Washington, IL 61571 | 2009-12-15 |
| 1700024916 | Julie Adams | Developmental Therapist | 700 S. Elm, Washington, IL 61571 | 2009-01-26 |
| 1851595128 | Michael John Herman | Dentist | 106 So Cummings Lane, Washington, IL 61571 | 2007-06-12 |
| 1861539132 | Gary Lee Cunningham | Dentist | 5 Laurel Ct., Washington, IL 61571 | 2007-01-30 |
| Find all providers in zip 61571 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619581576 | Brittney Boxley | Internal Medicine | 1113 Clifton St Nw, Washington, DC 20009-5206 | 2020-09-08 |
| 1154948362 | Hibiscus Medical Pllc | Internal Medicine | 1268 Delafield Pl Ne, Washington, DC 20017-2809 | 2020-07-03 |
| 1104454594 | Hoangmai Huu Pham | Internal Medicine | 1231 C St Ne, Washington, DC 20002-6368 | 2020-03-31 |
| 1992351399 | Richard Senzer Md LLC | Internal Medicine | 279 State Route 31 S Ste 1, Washington, NJ 07882-4099 | 2019-08-13 |
| 1336700160 | Northrium Health LLC | Internal Medicine | 1673 K Street #300 Nw, Washington, DC 20006 | 2019-06-24 |
| 1780158873 | Clinicians In Telemedicine LLC | Internal Medicine | 1678 Beeman Rd, Washington, WV 26181-5360 | 2019-01-11 |
| 1669942983 | It Hospitalist Services | Internal Medicine | United Medical Center, 1310 Southern Ave., Se, Washington, DC 20032-4623 | 2018-11-29 |
| 1619447380 | Michael Waters | Internal Medicine | 10 Samuel Dr, Washington, PA 15301-3206 | 2018-11-26 |
| 1851866198 | Washington Medical LLC | Internal Medicine | 1140 Varnum St Ne Ste 203, Washington, DC 20017-2153 | 2018-10-12 |
| 1124512819 | Internal Medicine Colleagues Pllc | Internal Medicine | 2021 K St Nw Ste 404, Washington, DC 20006-1003 | 2018-06-18 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 61571 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.