DR. CHARLES B JR. IDOM (M.D., FACS) – Urology Physician, NPI 1316943210

DR. CHARLES B JR. IDOM (M.D., FACS) is a healthcare provider. based in Dalton, Georgia. specializing in UROLOGY. They hold the professional credentials M.D., FACS. They hold a License No. 050482 (GA). The NPI Number for DR. CHARLES B JR. IDOM (M.D., FACS) is 1316943210

Main info

Male
Sole Proprietor
32 Years Of Experience
Accepts Medicare Assignment
Name
DR. CHARLES B JR. IDOM (M.D., FACS)
NPI
1316943210
Phone
(706) 278-5961
Address
1434 BROADRICK DR
Enumeration Date
24 June 2005
Deactivation Date
16 March 2006
Reactivation Date
31 March 2006
Last Update Date
11 September 2017

Doctor Profile

Medical School Name
UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Secondary Phone
7062785961114
Graduation Year
1994 (32 years ago)
PAC ID
6901883131
Group Practice PAC ID
1951388180
Professional Enrollment ID
I20040706000559
Address ID
GA307203009DA1434XDRXX300
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

362 UROLOGY in GA

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Provider Addresses for DR. CHARLES B JR. IDOM (M.D., FACS)

  • 1434, Broadrick Drive, Dalton, Whitfield County, Georgia, 30720, United States

    DALTON, GA 307203009

    Phone: (706) 278-5961

    Fax: (706) 275-0280

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 106 Open Payments records for all available years, with a total value of $3,008.

Total Amount is formed as General ($3,008) + Research ($0) + Ownership ($0) = $3,008.

Last reported payment date: 2024-12-19 • Largest payer in this snapshot: PROCEPT BioRobotics Corporation ($488).

Total Amount

$3,008

General + Research + Ownership

Payments

106

Total payment records

General Amount

$3,008

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-19

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-07-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040706000559IUrologyGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml4,10036$0
81000Manual urinalysis test with examination using microscope, non-automated1,317600$0
99213Established patient office or other outpatient visit, 20-29 minutes696455$0
99214Established patient office or other outpatient visit, 30-39 minutes558340$0
36415Insertion of needle into vein for collection of blood sample494303$0
View full utilization report →

Insurance plans in this area (ZIP 30720)

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Provider's Procedures

DR. CHARLES B JR. IDOM (M.D., FACS) performs procedures in UROLOGY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
UROLOGYGA55700Biopsy of prostate gland2525
UROLOGYGA74177CT scan of abdomen and pelvis with contrast1111
UROLOGYGA76942Ultrasonic guidance imaging supervision and interpretation for insertion of needle2424
UROLOGYGA81002Urinalysis, manual test8278

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1951388180View full group profile
NameSpecialtyState
Physician AssistantGA
U R O L O G YFL
P A T H O L O G YTN
Nurse PractitionerGA
U R O L O G YGA

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Frequently asked questions

What is DR. CHARLES B JR. IDOM (M.D., FACS)'s NPI number?
DR. CHARLES B JR. IDOM (M.D., FACS)'s NPI is 1316943210 — the number used across U.S. healthcare to identify this provider.
Would DR. CHARLES B JR. IDOM (M.D., FACS) appear as active to a payer?
You can treat DR. CHARLES B JR. IDOM (M.D., FACS) as active for directory purposes; confirm clinical privileges separately.
How would a patient describe DR. CHARLES B JR. IDOM (M.D., FACS)'s focus?
For DR. CHARLES B JR. IDOM (M.D., FACS), the primary taxonomy reads as Urology Physician. Clinical services aligned with this taxonomy classification.
What practice footprint exists for DR. CHARLES B JR. IDOM (M.D., FACS)?
Travel planning: use Dalton, Georgia as the reference point for DR. CHARLES B JR. IDOM (M.D., FACS), then confirm.
Can I trust this NPI listing for DR. CHARLES B JR. IDOM (M.D., FACS)?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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