NPIMap

Individual provider Active NPI

Matthew Champeau, PA

  • Physician Assistant
  • Bristol, CT
National Provider Identifier
1689654659
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001690 Issued in CT
Practice address
41 Brewster Rd
Bristol, CT 06010-5161
Phone
(860) 585-3000
Fax
(860) 585-3907
NPI assigned
Jan 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001690 CT Primary

Addresses

Primary practice location

41 Brewster Rd
Bristol, CT 06010-5161

Mailing address

PO Box 2699
Dept 200
Hartford, CT 06146-2699
Phone (866) 898-7138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051212000016 CT Practitioner - Physician Assistant 6103847793 Reassigns benefits to 6 organizations
I20170728000486 NH Practitioner - Physician Assistant 6103847793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bristol Hospital Multi Specialty Group, Inc.Group PAC ID 9032014758, 148 clinicians

Practice addresses (Care Compare)

41 Brewster Rd
Bristol, CT 06010-5161
Phone (860) 585-3000

539 Farmington Ave
Bristol, CT 06010-3931
Phone (860) 314-6046

Merit-based Incentive Payment System (MIPS)

Final score
88.05 of 100Reported as group
Quality
70.34
Promoting interoperability
100
Improvement activities
40
Cost
75.39

Merit-based Incentive Payment System (MIPS)

Final score
95.62 of 100Reported as group
Quality
84.96
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1278NHMDPsychologist
001690CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte Hungerford Hospital CurrentSince Nov 1, 2013 Accepting new patients
Saint Raphael Faculty Physicians Physician Assistant Past Accepting new patients
CT Emergency Medicine Specialists, LLC Past Accepting new patients
Medhelp PC Past Accepting new patients

Locations

540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17217/brand/1/csg/1/fhir/r4
  • Direct secure messaging: matthew.champeau@xdr.hhchealthdirect.org

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1689654659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "address_2": "DEPT 200",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061462699",
            "telephone_number": "866-898-7138",
            "fax_number": "616-975-9824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 BREWSTER RD",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105161",
            "telephone_number": "860-585-3000",
            "fax_number": "860-585-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPEAU",
        "first_name": "MATTHEW",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

Sources for this page

Verify at the official NPI Registry.