Active NPI
Patricia J Champlin, ANP
- Nurse Practitioner
- West Seneca, NY
National Provider Identifier
1366400699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 300246
- Practice address
- 120 Gardenville Pkwy W
West Seneca, NY 14224 - Phone
- (716) 668-3600
- Fax
- (716) 606-4003
- NPI assigned
- May 3, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 300246 | NY | Primary |
Addresses
Primary practice location
120 Gardenville Pkwy W
West Seneca, NY 14224
Mailing address
800 Carter Street
Attn Kelly Steele
Rochester, NY 14621
Phone (585) 339-4793
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10767064 | Other | NY | CAQH |
| 9513172 | Other | NY | IHA |
| P00189067 | Other | NY | MEDICARE RAILROAD |
| 000560338004 | Other | NY | BCBS |
| 159955BJ | Other | NY | PREFERRED CARE |
| 040511000506 | Other | NY | FIDELIS |
Other names 1
- Patricia J Champlin Czumaj
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050208000870 | NY | Practitioner - Nurse Practitioner | 7618928599 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300246 | NY | MD | Neurological Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366400699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 CARTER STREET",
"address_2": "ATTN KELLY STEELE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "14621",
"telephone_number": "585-339-4793",
"fax_number": "585-336-4845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 GARDENVILLE PKWY W",
"city": "WEST SENECA",
"state": "NY",
"postal_code": "14224",
"telephone_number": "716-668-3600",
"fax_number": "716-606-4003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMPLIN",
"first_name": "PATRICIA",
"middle_name": "J",
"credential": "ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NY",
"license": "300246",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10767064",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHA",
"identifier": "9513172",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00189067",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000560338004",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "159955BJ",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "040511000506",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PATRICIA",
"last_name": "CHAMPLIN CZUMAJ",
"middle_name": "J",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in West Seneca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.