Active NPI
Brooke Davis Champion, PA-C
- Physician Assistant
- Raleigh, NC
National Provider Identifier
1336713254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-11889
- Practice address
- 8331 Bandford Way Ste 101
Raleigh, NC 27615-2765 - Phone
- (919) 841-4566
- NPI assigned
- May 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-11889 | NC | Primary |
Addresses
Primary practice location
8331 Bandford Way Ste 101
Raleigh, NC 27615-2765
Mailing address
95 Fall Harvest CT
Franklinton, NC 27525-8450
Phone (919) 616-8570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- East Carolina University School of Dentistry, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8331 Bandford Way
Suite 101
Raleigh, NC 27615-2765
Phone (919) 841-4566
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- northraleighfamilymed.brookechampion@136519.advancedmd-direct.com
Organizations & group practices 2
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.
-
- Family Nurse Practitioner
- Raleigh, NC
- NPI 1609903228
-
- Urgent Care Clinic/Center
- Chapel Hill, NC
- NPI 1003484734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657152000000",
"number": "1336713254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 FALL HARVEST CT",
"city": "FRANKLINTON",
"state": "NC",
"postal_code": "275258450",
"telephone_number": "919-616-8570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8331 BANDFORD WAY STE 101",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276152765",
"telephone_number": "919-841-4566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMPION",
"first_name": "BROOKE",
"middle_name": "DAVIS",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-15",
"last_updated": "2022-07-07",
"certification_date": "2022-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-11889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.