NPIMap

Individual provider Active NPI

Jennifer Champagne, NP-C

  • Adult Health Nurse Practitioner
  • Picayune, MS
National Provider Identifier
1235529454
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R871326 Issued in MS
Practice address
2797 Cooper Rd
Picayune, MS 39466-2213
Phone
(601) 799-1616
NPI assigned
Jan 26, 2015
Last updated
Jul 21, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R871326 MS Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617001010 MS Practitioner - Nurse Practitioner 6901117985 Reassigns benefits to 1 organization
Practice locations: Picayune, MS

Care Compare profile

Medicare Care Compare
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 GulfportGroup PAC ID 2466524012, 473 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R871326MSMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Oct 1, 2017 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Oct 1, 2017 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

1001 Benigno Ln
Bay St Louis, MS 39520
Phone (228) 467-1414

952 Green Meadow Rd
Bay St Louis, MS 39520
Phone (228) 463-1649

1340 Broad Ave
Ste 310
Gulfport, MS 39501
Phone (228) 575-1400

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4855

8970 Lorraine Rd
Gulfport, MS 39503
Phone (228) 575-1787

5120 Beatline Rd
#B
Long Beach, MS 39560
Phone (228) 867-5185

Interoperability endpoints

  • Direct secure messaging: jchampagne@direct.mhg.com

Organizations & group practices 5

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.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1235529454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30030 ROAD 202",
            "city": "CARRIERE",
            "state": "MS",
            "postal_code": "394269208",
            "telephone_number": "601-590-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2797 COOPER RD",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394662213",
            "telephone_number": "601-799-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPAGNE",
        "first_name": "JENNIFER",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-26",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MS",
            "license": "R871326",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "R871326",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "R871326",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Picayune, MS

Sources for this page

Verify at the official NPI Registry.