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CHARLES ANDERSON
NPI 1790172013
Marriage & Family Therapist in Fairfield, CA

Active since April 24, 2015PECOS Enrolled
825 WEBSTER ST STE D, FAIRFIELD, CA 94533(707) 386-8066(707) 673-2800 Get Directions Write a Review

NPPES record last updated: July 15, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 15, 2020, Mar 4, 2019 (2 updates tracked since 2019).

About Charles Anderson NPPES

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

CHARLES ANDERSON (NPI 1790172013) is an individual marriage & family therapist in Fairfield, California, licensed in California (110738) and active in the NPI registry since April 2015. He is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1790172013
Entity TypeIndividualMale
Primary Taxonomy106H00000X
Provider Legal NameCHARLES ANDERSON
Location Address825 WEBSTER ST STE DFairfield, CA 94533-5522
Mailing Address825 Webster St Ste DFairfield, CA 94533-5522 · (707) 386-8066 · Fax (707) 447-3205
Phone(707) 386-8066
Fax(707) 673-2800
Sole ProprietorYes
Medical School CMSOtherGraduated 2016
Enumeration DateApril 24, 2015
Last NPPES UpdateJuly 15, 20202 updates tracked since enumeration
NPPES CertifiedJuly 15, 2020
✔ NPI 1790172013 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 110738
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
825 WEBSTER ST STE D, Fairfield, CA 94533
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID1850672023
PECOS Enrollment IDI20260810003111
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 Reassignment

Medicare enrollment records show Charles Anderson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

My Niche Family Therapy Professional Corporation
Same address
Marriage & Family Therapist
825 WEBSTER ST STE B
Fairfield, CA 94533
  • Reassigned Medicare billing, California enrollment
NPI 1801755269 (707) 475-3203

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

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 Anderson's NPI number?

The NPI number for Charles Anderson is 1790172013. It was assigned to this individual provider in the NPPES registry on April 24, 2015.

Where is Charles Anderson located?

Charles Anderson practices at 825 Webster St Ste D, Fairfield, CA 94533. The listed phone number is (707) 386-8066.

What is Charles Anderson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Charles Anderson enrolled in Medicare?

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

Which organization bills Medicare for Charles Anderson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Charles Anderson reassigns Medicare benefits to My Niche Family Therapy Professional Corporation (Fairfield, CA). The 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 Anderson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Charles Anderson was last updated on July 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.