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

Q: 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.

Q: What is Charles Pankow's specialty?

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

Q: 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 5 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.

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: August 02, 2026.

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

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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

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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.Insurance ›

Medicare Participation & PECOS CMS

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

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

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.

Hospital Affiliations CMS Care Compare 2

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

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.

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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