Jennie Stover Champion, M.D.

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

MD28609 Issued in OR

Practice address

2801 N Gantenbein Ave
Ste 3135
Portland, OR 97227-1623

Phone

(503) 413-2632

NPI assigned

Jun 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Jennie Elizabeth Stover Former name

Medicare fee-for-service enrollment

Enrolled in OR, MT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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.

• Legacy Emanuel Hospital & Health Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1831112358
  Medicare reassignment NPD
• SCL Health Medical Group - Billings LLC

  • Clinic/Center
  • Billings, MT
  • NPI 1508289703
  Medicare reassignment NPD
• Legacy Emanuel Hospital & Health Center

  • Community/Retail Pharmacy
  • Portland, OR
  • NPI 1417977976
  NPD
• Legacy Emanuel Hospital & Health Center

  • Clinic/Center
  • Portland, OR
  • NPI 1700809027
  NPD
• SCL Health Medical Group - Billings LLC

  • Gynecologic Oncology Physician
  • Billings, MT
  • NPI 1114601549
  NPD
• SCL Health Medical Group - Billings, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Billings, MT
  • NPI 1003701558
  NPD

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463529600000",
    "number": "1114965498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE",
            "address_2": "STE 3135",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N GANTENBEIN AVE",
            "address_2": "STE 3135",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271623",
            "telephone_number": "503-413-2632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "JENNIE",
        "middle_name": "STOVER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2016-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MA",
            "license": "224172",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NM",
            "license": "MD2011-0496",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "OR",
            "license": "MD28609",
            "primary": true
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "VT",
            "license": "042.0012363",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIE",
            "last_name": "STOVER",
            "middle_name": "ELIZABETH",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tamila M Chamorro Jacobs, QMHA
• Maiya Amar Champa
• Allison Guyn Champagne, DC
• Devyn Nicole Champagne, DC
• Shannon Champagne, LCSW
• Joshua Champion, MD
• Lauren Meredith Champion, D.O.
• Laurissa Marie Champion, DMD
• Lillian Jade Champion
• Matthew Champion, M.D.

• Pediatric Critical Care Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatric Critical Care Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.