Jesse Aaron Champagne

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2016004506 Issued in MO

Practice address

900 W Nifong Blvd
Ste 101
Columbia, MO 65203-4467

Phone

(573) 815-6631

Fax

(573) 815-6634

NPI assigned

Jul 13, 2013

Last updated

May 3, 2016By the provider in NPPES

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 MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Mattoon, IL
  • NPI 1063030252

  MO

  Medicare reassignment NPD
• Boone Physician Services, LLC

  • Multi-Specialty Clinic/Center
  • Columbia, MO
  • NPI 1760893259
  NPD (past)

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

{
    "created_epoch": "1373673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1114368511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "573-815-6631",
            "fax_number": "573-815-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W NIFONG BLVD",
            "address_2": "STE 101",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034467",
            "telephone_number": "573-815-6631",
            "fax_number": "573-815-6634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPAGNE",
        "first_name": "JESSE",
        "middle_name": "AARON",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-13",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP07350",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2016004506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Wheeler Alexander Chamberlain, M.D.
• Jacob R Chambers, DC
• Kimberly Ann Chambers, HIS
• Megan Chambers, RN
• Randall Elizabeth Chambers, BCBA
• Albert Chan, M.D.
• Frank Chan, MD
• Lina Chan, MD
• Violet Chandler
• Charlotte Lin Chang, MD

• Family Nurse Practitioner in Columbia, MO
• Providers in Columbia, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; 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.