Jennifer Champagne, NP-C
Individual provider Active NPI Adult Health Nurse Practitioner · Picayune, MS
NPI 1235529454 · NPPES record last updated Jul 21, 2016
Key facts
- NPI
- 1235529454
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- R871326 (MS)
- Practice address
- 2797 Cooper Rd
Picayune, MS 39466-2213 - Phone
- (601) 799-1616
- NPI assigned
- Jan 26, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 61
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Memorial Hospital at Gulfport
Practice addresses (Care Compare)
1001 Benigno LN
Bay St Louis, MS 39520-1602
Phone (228) 467-1414
1009 Benigno LN
Bay Saint Louis, MS 39520-1602
Phone (228) 467-2555
1340 Broad Ave
Gulfport, MS 39501-2460
1340 Broad Ave
Gulfport, MS 39501-2465
1404 44TH Ave
Gulfport, MS 39501-2554
Phone (228) 575-2870
1408 44TH Ave
Gulfport, MS 39501-2554
Phone (228) 575-1777
Hospital & facility affiliations
- Mississippi Homecare of Picayune
- Memorial Hospital at Gulfport
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150617001010 | MS | Practitioner - Nurse Practitioner | 6901117985 |
Reassigns benefits to 1 organization Practice locations: Picayune, MS |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R871326 | MS | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Past | Accepting new patients |
Locations
952 Green Meadow Rd
Bay St Louis, MS 39520
Phone (228) 463-1649
1001 Benigno Ln
Bay St Louis, MS 39520
Phone (228) 467-1414
1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856
8970 Lorraine Rd
Gulfport, MS 39503
Phone (228) 575-1787
1340 Broad Ave
Ste 310
Gulfport, MS 39501
Phone (228) 575-1400
5120 Beatline Rd
#B
Long Beach, MS 39560
Phone (228) 867-5185
Interoperability endpoints
- jchampagne@direct.mhg.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | R871326 | MS | Yes |
| Gerontology Nurse Practitioner | 363LG0600X | R871326 | MS | |
| Primary Care Nurse Practitioner | 363LP2300X | R871326 | MS |
Addresses
Primary practice location
2797 Cooper Rd
Picayune, MS 39466-2213
Mailing address
30030 Road 202
Carriere, MS 39426-9208
Phone (601) 590-1459
Other providers in Picayune, MS
- Mekdes Ericka Carpenter
- Raquel Nichole Carroll
- Kimberly J Carver
- Tracy Anne Casey
- Daiwana D Certain
- Vincent E Cheshire
- Child Abuse Education Council of Pearl River County, Inc.
- Children'S International, LLC
- Children'S International, LLC
- City Caremeds Pharmacy LLC
All providers in Picayune, MS · Adult Health Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.