Champaign County

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

License

034599 Issued in OH

Legal business name

CHAMPAIGN COUNTY

Practice address

1512 S US Highway 68
Suite Q100
Urbana, OH 43078-9198

Phone

(937) 484-1605

Fax

(937) 484-1622

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Stacey A Thomas, BSN RN

Title

Director of Nursing

Phone

(937) 484-1619

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Tax ID family

Champaign County3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Champaign County Board MRDD

  • Developmentally Disabled Services Day Training Agency
  • Urbana, OH
  • NPI 1629191416
  NPD tax ID
• The Champaign County Board of Commissioners

  • Nursing Facility/Intermediate Care Facility
  • Urbana, OH
  • NPI 1124184924
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Don Clark, MD

  • Family Medicine Physician
  • Marietta, OH
  • NPI 1053316364
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509321600000",
    "number": "1285754994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 S US HIGHWAY 68",
            "address_2": "SUITE Q100",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "430789198",
            "telephone_number": "937-484-1605",
            "fax_number": "937-484-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 S US HIGHWAY 68",
            "address_2": "SUITE Q100",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "430789198",
            "telephone_number": "937-484-1605",
            "fax_number": "937-484-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPAIGN COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2017-10-30",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "937-484-1619",
        "authorized_official_credential": "BSN RN"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "OH",
            "license": "034599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2410699",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Carter
• Brianne Castle
• Cheyenne Casto
• Jason Rex Casto
• Anne Emily Cauley, LSW
• Champaign County Board MRDD
• Champaign Dental Group, Inc.
• Champaign Residential Services, Inc.
• Champaign Residential Services, Inc.
• Champaign Residential Services, Inc.

• Public Health or Welfare Agency in Urbana, OH
• Providers in Urbana, OH by specialty
• Public Health or Welfare Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.