Archie Joel Champion III, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003747 Issued in GA

Practice address

3301 First Street East
Suite a
Vidalia, GA 30474

Phone

(912) 537-4411

Fax

(912) 538-8485

NPI assigned

Apr 26, 2006

Last updated

Jul 29, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mark Spivey Orthopedic Clinic LLCGroup PAC ID 5395797336, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Health Meadows Hospital Hospital, Vidalia, GA, CCN 110128
• Fairview Park Hospital Hospital, Dublin, GA, CCN 110125

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: achampion@spiveyortho.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark Spivey Orthopedic Clinic, LLC

  • Orthopaedic Surgery Physician
  • Vidalia, GA
  • NPI 1104017821
  Medicare reassignment Care Compare group
• Dublin Orthopaedics & Rehabilitation, Inc

  • Orthopaedic Surgery Physician
  • Dublin, GA
  • NPI 1306038807
  NPD (past)

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

• Fairview Park, Limited Partnership

  dba Fairview Park Hospital

  • General Acute Care Hospital
  • Dublin, GA
  • NPI 1285688234
  Care Compare affiliation
• Vidalia Health Services, LLC

  • General Acute Care Hospital
  • Vidalia, GA
  • NPI 1790376564
  Care Compare affiliation

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280361600000",
    "number": "1710944681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 FIRST STREET EAST",
            "address_2": "SUITE A",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-537-4411",
            "fax_number": "912-538-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 FIRST STREET EAST",
            "address_2": "SUITE A",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-537-4411",
            "fax_number": "912-538-8485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "ARCHIE",
        "middle_name": "JOEL",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2010-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019893311A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin J Carter, MPAS, PA-C
• Wilton Todd Carter
• Brenna Casey, DO
• Virginia Grace Gourley Cato, PHARMD, RPH
• Ann Marie Chalker, CRNA
• Chapman Healthcare Pharmacy Inc (Chapman Pharmacy)
• Chapman Healthcare Pharmacy Inc TLC (Chapman Pharmacy)
• Chapman Healthcare Serv Inc.
• George Wesley Chapman, PHARMACIST
• Chauncy Montgomery (The Secret Place)

• Physician Assistant in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; 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.