Jacob Anthony Champagne, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

224252 Issued in LA

Practice address

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917

Phone

(337) 470-2911

NPI assigned

Feb 9, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acadiana Acute Care Associates, LLCGroup PAC ID 0547390056, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of Lourdes Regional Medical Center, Inc Hospital, Lafayette, LA, CCN 190102

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Acadiana Acute Care Associates, LLC

  • Emergency Medicine Physician
  • Lafayette, LA
  • NPI 1255566626

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

• Our Lady of Lourdes Regional Medical Center, Inc

  • General Acute Care Hospital
  • Lafayette, LA
  • NPI 1598766495
  Care Compare affiliation

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1508510413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 MADDOX JUDE DR",
            "city": "MAURICE",
            "state": "LA",
            "postal_code": "705553355",
            "telephone_number": "337-230-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 AMBASSADOR CAFFERY PKWY",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086917",
            "telephone_number": "337-470-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPAGNE",
        "first_name": "JACOB",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "224252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gay G Chalpin, LCSW
• Eduardo M Chamah, M.D.
• David B Chambers, DDS
• Julie M Chambers, LPC
• Bradley Paul Champagne, M.D.
• Jessica Champagne, FNP
• Kenneth J. Champagne, M.D.
• Lindsey Quinn Champagne, DPT
• Chance to Change Supportive Services of Louisiana Inc
• Clay Steven Chandler, DDS, MD

• Nurse Practitioner in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.

Verify at the official NPI Registry.