NPIMap

Organization Active NPI

Champions Clinical Services, LLC

  • Surgery Physician
  • Augusta, GA
National Provider Identifier
1033928650
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CHAMPIONS CLINICAL SERVICES, LLC
Practice address
1537 Walton Way
Augusta, GA 30904-3764
Phone
(706) 731-1200
NPI assigned
Jan 7, 2025
Last updated
Jan 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Authorized official

Name
Dr. Jon Christopher Gibbs, MDNPI 1700896156
Title
Owner
Phone
(706) 831-0204

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

1537 Walton Way
Augusta, GA 30904-3764

Mailing address

3660J J Dewey Gray Cir
Augusta, GA 30909-6424
Phone (706) 504-4651

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250314000639 GA Part B Supplier - Clinic/Group Practice 6305368788 Receives reassigned benefits from 9 practitioners
Practice locations: Augusta, GA

National Provider Directory

National Provider Directory

Locations

3660 J Dewey Gray Cir
#J
Augusta, GA 30909

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1033928650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660J J DEWEY GRAY CIR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096424",
            "telephone_number": "706-504-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1537 WALTON WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309043764",
            "telephone_number": "706-731-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPIONS CLINICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-831-0204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.