Individual provider Active NPI

Cheryl Champion, LICSW

  • Clinical Social Worker
  • Coon Rapids, MN
National Provider Identifier
1265575542
Registry record updated Apr 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11195 Issued in MN
Practice address
1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708
Phone
(763) 427-7964
Fax
(763) 427-7976
NPI assigned
Feb 15, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 11195 MN Primary

Addresses

Primary practice location

1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708

Mailing address

1930 Coon Rapids Blvd NW
Coon Rapids, MN 55433-4708
Phone (763) 427-7964

Other identifiers 6

IdentifierTypeStateIssuer
1265575542OtherMNBLUE CROSS BLUE SHIELD OF MINNESOTA
1265575542OtherMNMEDICARE
1265575542MedicaidMN
1265575542OtherMNMETROPOLITAN HEALTH PLAN
1265575542OtherMNHEALTH PARTNERS
1265575542OtherMNMEDICA (UBH)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090204000103 MN Practitioner - Clinical Social Worker 8224192356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Insight Counseling Duluth LLCGroup PAC ID 4486911187, 13 clinicians

Practice addresses (Care Compare)

225 1St St N
Suite 3100B
Virginia, MN 55792-2457
Phone (218) 481-7660

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Insight Counseling Duluth, LLC Clinical CurrentSince Nov 8, 2017 Accepting new patients

Locations

306 W Superior St
Ste 1000
Duluth, MN 55802
Phone (218) 428-1175

225 1st St N
Ste 3100B
Virginia, MN 55792
Phone (218) 481-7660

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239062400000",
    "number": "1265575542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "763-427-7964",
            "fax_number": "763-427-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334708",
            "telephone_number": "763-427-7964",
            "fax_number": "763-427-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "CHERYL",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2009-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "11195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MINNESOTA",
            "identifier": "1265575542",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1265575542",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265575542",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METROPOLITAN HEALTH PLAN",
            "identifier": "1265575542",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "1265575542",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA (UBH)",
            "identifier": "1265575542",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.