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CHARLES PANKOW JR. CRNP
NPI 1174366884
Nurse Practitioner in Philadelphia, PA

Active since June 18, 2024PECOS EnrolledAccepts Medicare Assignment
330 SOUTH NINTH STREET, PHILADELPHIA, PA 19107(215) 662-3606(215) 829-6606 Get Directions Write a Review

NPPES record last updated: February 18, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 6, 2026, Jan 6, 2026, Jul 12, 2024 and 1 more (4 updates tracked since 2024).

About Charles Pankow Jr. Crnp NPPES

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

CHARLES PANKOW JR. CRNP (NPI 1174366884) is an individual nurse practitioner in Philadelphia, Pennsylvania, licensed in Pennsylvania (SP034276) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS, is affiliated with Lee Memorial Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1174366884
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameCHARLES PANKOW JR.Credential: CRNP
Location Address330 SOUTH NINTH STREETPhiladelphia, PA 19107-6103
Mailing Address330 South Ninth StreetPhiladelphia, PA 19107-6103 · (215) 662-3606 · Fax (215) 829-6606
Phone(215) 662-3606
Fax(215) 829-6606
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateJune 18, 2024
Last NPPES UpdateFebruary 18, 20264 updates tracked since enumeration
NPPES CertifiedFebruary 18, 2026
✔ NPI 1174366884 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in PA · SP034276
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License APRN11033483 (FL)
330 SOUTH NINTH STREET, Philadelphia, PA 19107
Open in Google Maps ↗

Secondary Practice Locations 2

Location 113685 Doctors Way Ste 350Fort Myers, FL 33912-4347 · Phone (239) 343-3800 · Fax (239) 343-3993
Location 23132 Royal Gardens AveFort Myers, FL 33916-4580 · Phone (239) 994-3350

Other Identifiers 1

Medicaid122896600FL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Charles Pankow Jr. Crnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668919317
PECOS Enrollment IDI20240731001261, I20260206000633
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.

Medicare Billing Reassignments

3

Medicare enrollment records show Charles Pankow reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

University Of Penn-Medical Group
0.1 mi
Ambulatory Fertility Facility
801 SPRUCE ST, 8TH FLOOR
Philadelphia, PA 19107
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 3,488 clinicians in this Medicare group
NPI 1669860854 (215) 829-2345
Lee Memorial Health System
995 mi
Federally Qualified Health Center (FQHC)
3210 DR MARTIN LUTHER KING BLVD
Fort Myers, FL 33916
  • Reassigned Medicare billing, Florida enrollment
  • 1,345 clinicians in this Medicare group
NPI 1447099973 (239) 343-6050
Lee Health System Inc
1,005 mi
Internal Medicine
9981 S HEALTHPARK DR
Fort Myers, FL 33908
  • Reassigned Medicare billing, Florida enrollment
  • 1,899 clinicians in this Medicare group
NPI 1942058557 (239) 424-1500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Lee Memorial Hospital

Acute Care Hospitals · Fort Myers, FL
5/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number100012
Location2776 Cleveland AveFort Myers, FL 33901 · Lee County
Emergency services Birthing friendly

Gulf Coast Medical Center Lee Health

Acute Care Hospitals · Fort Myers, FL
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number100220
Location13681 Doctors WayFort Myers, FL 33912 · Lee County
Emergency services

Pennsylvania Hospital

Acute Care Hospitals · Philadelphia, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390226
Location800 Spruce StreetPhiladelphia, PA 19107 · Philadelphia County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19107 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
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$105.21 typical visit price
range $19.30 – $147.29
Typical copayment $26.30 (range $4.82 – $36.82)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 8

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

DR. LAUREN HART HAMMER MD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
REBECCA WILLIAMSON MD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
CHARLES FRANCIS PALMER III MD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
DR. HOLLY CONSTANCE ELSER MD, PHD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
MOIRA ENGLAND FLANIGAN MD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET, APT. 327
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
STEPHEN D ARADI MD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
DR. PATRICK THOMAS EBBERT MD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606
LINDSAY AGOSTINELLI MD, PHD
Psychiatry & Neurology (Neurology)
330 SOUTH NINTH STREET
PHILADELPHIA, PA 19107
Philadelphia County (215) 662-3606

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 Pankow's NPI number?

The NPI number for Charles Pankow is 1174366884. It was assigned to this individual provider in the NPPES registry on June 18, 2024.

Where is Charles Pankow located?

Charles Pankow practices at 330 South Ninth Street, Philadelphia, PA 19107. The listed phone number is (215) 662-3606.

What is Charles Pankow's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Charles Pankow enrolled in Medicare?

Yes. Charles Pankow is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Charles Pankow's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Charles Pankow reassigns Medicare benefits to 3 organizations: University Of Penn-Medical Group (Philadelphia, PA), Lee Memorial Health System (Fort Myers, FL) and Lee Health System Inc (Fort Myers, FL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Charles Pankow's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Charles Pankow affiliated with any hospitals?

According to CMS data, Charles Pankow is affiliated with Lee Memorial Hospital, Gulf Coast Medical Center Lee Health and Pennsylvania Hospital.

When was this NPI record last updated?

The NPPES record for Charles Pankow was last updated on February 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months 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.