Jaden Elijah Champion

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

108234 Issued in CA

Practice address

4785 N First St
Fresno, CA 93726

Phone

(559) 448-4879

NPI assigned

Jun 27, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Central Star Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Fresno, CA
  • NPI 1255218905
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1003336397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4785 N FIRST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93726",
            "telephone_number": "559-448-4879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4785 N FIRST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93726",
            "telephone_number": "559-448-4879"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1255 Kendall Road",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "93401",
            "country_code": "US",
            "telephone_number": "805-781-3535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2002 N Fine Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937271511",
            "country_code": "US",
            "telephone_number": "559-457-6975",
            "fax_number": "559-457-5896",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4441 E Kings Canyon Rd",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937023604",
            "country_code": "US",
            "telephone_number": "559-600-9171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3133 N Millbrook Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937031425",
            "country_code": "US",
            "telephone_number": "559-600-9180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2934 N Fresno St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937031123",
            "country_code": "US",
            "telephone_number": "559-549-6697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "JADEN",
        "middle_name": "ELIJAH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "91813",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "108234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Andrew Chambers, N/A
• Robert D Chambers, MD
• Anna Marie Champ
• Wendy Champaheuang
• Judy L. Champaign, M.D.
• Karalyn Rebecca Champion, FNP
• Nathan Samuel Champion
• Patricia Champlin
• Chan Lee Professional Corporation
• Ada Wai Chan, M.D.

• Clinical Social Worker in Fresno, CA
• Providers in Fresno, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.