Antonio D Champion, PH.D., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.027393 Issued in IL

Practice address

2109 S 8TH Ave
Maywood, IL 60153-3230

Phone

(708) 356-6386

NPI assigned

Jul 29, 2024

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

Not listed in the public Medicare enrollment file

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.

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1619706520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 S 8TH AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533230",
            "telephone_number": "708-356-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 S 8TH AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533230",
            "telephone_number": "708-356-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "ANTONIO",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PH.D., LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.027393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Chae, M.D.
• Sthitadhi Chakraborty, MD
• Joy Malenie Chaksupa, CRNA
• Meenakshi Chaku, M.D.
• Malliswari Challapalli, MD
• Dennis Chan, MD
• Kelley Chan
• Kenneth Kin Kan Chan, M.D.
• Kim Hoe Chan, MD
• Lucas Chan, M.D.

• Clinical Social Worker in Maywood, IL
• Providers in Maywood, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.