Champ Phuphanich, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

224407 Issued in LA

Practice address

305 E 1St St
Thibodaux, LA 70301-3341

Phone

(985) 228-6028

NPI assigned

Mar 4, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Mary Emergency Group LLCGroup PAC ID 7810926995, 16 clinicians

Independence Emergency Group LLCGroup PAC ID 4284759325, 20 clinicians

Bayoumd Urgent Healthcare LLCGroup PAC ID 6507217452, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HAGDDD/Endpoint/HAGDDD

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.

• Bayoumd Urgent Healthcare LLC

  • Urgent Care Clinic/Center
  • Thibodaux, LA
  • NPI 1306628508
  Medicare reassignment Care Compare group NPD
• Independence Emergency Group LLC

  • Emergency Medicine Physician
  • Metairie, LA
  • NPI 1528384773

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• St Mary Emergency Group LLC

  • Emergency Medicine Physician
  • Morgan City, LA
  • NPI 1235108499

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• South Louisiana Medical Associates

  • Surgery Physician
  • Houma, LA
  • NPI 1942301379

  Family

  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  LA, Nurse Practitioner

  Medicare reassignment NPD
• South Louisiana Medical Associates

  • Durable Medical Equipment & Medical Supplies
  • Houma, LA
  • NPI 1699218131
  NPD

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1023765427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E 1ST ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703013341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E 1ST ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703013341",
            "telephone_number": "985-228-6028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1990 Industrial Blvd",
            "address_purpose": "LOCATION",
            "city": "Houma",
            "state": "LA",
            "postal_code": "703637055",
            "country_code": "US",
            "telephone_number": "985-868-9300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUPHANICH",
        "first_name": "CHAMP",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-04",
        "last_updated": "2024-04-16",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "224407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "n/a",
            "affiliation": "N",
            "endpointDescription": "n/a",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "n/a",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "n/a",
            "address_1": "1990 Industrial Blvd",
            "city": "Houma",
            "state": "LA",
            "country_code": "US",
            "postal_code": "703637055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Krysten Hymel Perque, FNP
• Toni Pesson
• Lauren Baylee Petrus
• Wayne Joseph Pharo, M.D.
• Monique Phillips
• Carol Pierre, BA
• Jasmin U. Pierre, PLPC
• Lisa D Pinell, M.A., CCC-SLP
• Kyle Piner, DPM
• Corrine Pitre, CCC-SLP

• Family Nurse Practitioner in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.