Dr Charles B Idom Jr, MD, FACS is a medicare enrolled "Urology" physician in Dalton, Georgia. He went to University Of Mississippi School Of Medicine and graduated in 1994 and has 30 years of diverse experience with area of expertise as Urology. He is a member of the group practice North Georgia Urology Center, Pc, Inc and his current practice location is
1434 Broadrick Dr, Dalton, Georgia. You can reach out to his office (for appointments etc.) via phone at
(706) 278-5961.
Dr Charles B Idom Jr is licensed to practice in Georgia (license number 050482) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1316943210.
Physician's Profile
| Full Name | Dr Charles B Idom Jr |
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| Gender | Male |
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| Speciality | Urology |
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| Experience | 30 Years |
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| Location | 1434 Broadrick Dr, Dalton, Georgia |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Charles B Idom Jr attended and graduated from University Of Mississippi School Of Medicine in 1994
NPI Data:
- NPI Number: 1316943210
- Provider Enumeration Date: 06/24/2005
- Last Update Date: 09/11/2017
Medicare PECOS Information:
- PECOS PAC ID: 6901883131
- Enrollment ID: I20040706000559
Medical Identifiers
Medical identifiers for Dr Charles B Idom Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1316943210 | NPI | - | NPPES |
| 340019475 | Other | GA | RAILROAD MEDICARE |
| 00931312A | Medicaid | GA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208800000X | Urology | 050482 (Georgia) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| North Georgia Urology Center, Pc, Inc | 1951388180 | 5 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Charles B Idom Jr allows following entities to bill medicare on his behalf.
| Entity Name | North Georgia Urology Center, Pc, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1861413197
PECOS PAC ID: 1951388180
Enrollment ID: O20040706000589 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Charles B Idom Jr is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Charles B Idom Jr, MD, FACS
1434 Broadrick Dr,
Dalton, GA 30720-3009
Ph: (706) 278-5961 | Dr Charles B Idom Jr, MD, FACS
1434 Broadrick Dr,
Dalton, GA 30720-3009
Ph: (706) 278-5961 |
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