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CHARLES MELLOR PA
NPI 1114014032
Physician Assistant in Port Jefferson, NY

Active since October 10, 2006PECOS Enrolled
91.25/100
CMS Quality Rating
75 N COUNTRY RD, PORT JEFFERSON, NY 11777(631) 473-1320(631) 686-7653 Get Directions Write a Review

NPPES record last updated: October 22, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Charles Mellor Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLES MELLOR PA (NPI 1114014032) is an individual physician assistant in Port Jefferson, New York, licensed in New York (004335) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114014032
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameCHARLES MELLORCredential: PA
Location Address75 N COUNTRY RDPort Jefferson, NY 11777-2119
Mailing Address75 N Country RdPort Jefferson, NY 11777-2119 · (631) 473-1320 · Fax (631) 686-7653
Phone(631) 473-1320
Fax(631) 686-7653
Sole ProprietorNo
Enumeration DateOctober 10, 2006
Last NPPES UpdateOctober 22, 2015
✔ NPI 1114014032 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 004335
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
75 N COUNTRY RD, Port Jefferson, NY 11777
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Other Identifiers 1

Medicare UPINP3296NY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Charles Mellor Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11777 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

91.25/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality74.92
Promoting Interoperability91.67
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTINA CATHERINE MELLONE DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
AAKAASH VARMA MD
Dermatology
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
KRISELA VOJNIKU MD
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
LORETTA DIDWELL
Physician Assistant
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
RAYMOND WONG
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-7654
KATLYN ANN CONVILLE ANTHONY NP
Nurse Practitioner (Family)
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2565
SHEHNAZ WASIM MD
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-1443
JULIA KOROBENKO DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Mellor's NPI number?

The NPI number for Charles Mellor is 1114014032. It was assigned to this individual provider in the NPPES registry on October 10, 2006.

Where is Charles Mellor located?

Charles Mellor practices at 75 N Country Rd, Port Jefferson, NY 11777. The listed phone number is (631) 473-1320.

What is Charles Mellor's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Charles Mellor enrolled in Medicare?

Yes. Charles Mellor is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Charles Mellor was last updated on October 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.