Individual provider Active NPI

Jennifer Champa, FNP

  • Nurse Practitioner
  • Weymouth, MA
National Provider Identifier
1801200175
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN281275 Issued in MA
Practice address
55 Fogg Rd
Weymouth, MA 02190-2432
Phone
(781) 624-8000
NPI assigned
Jun 16, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 281275 MA
Family Nurse Practitioner 363LF0000X 281275 MA
Nurse Practitioner 363L00000X RN281275 MA Primary

Addresses

Primary practice location

55 Fogg Rd
Weymouth, MA 02190-2432

Mailing address

55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 624-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20141002001522 MA Practitioner - Nurse Practitioner 7214157825 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Medical AssociatesGroup PAC ID 7113029257, 443 clinicians

Practice addresses (Care Compare)

55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 792-4136

Hospital & facility affiliations

  • South Shore Hospital Hospital, South Weymouth, MA, CCN 220100
  • Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN281275MAMDNurse Practitioner
281275MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians of Massachusetts Inc CurrentSince Sep 9, 2015 Accepting new patients
Steward Medical Group, Inc CurrentSince Aug 5, 2014 Accepting new patients
Steward Medical Group, Inc CurrentSince Aug 5, 2014 Accepting new patients
Sound Physicians of Massachusetts, Inc Nurse Practitioner CurrentSince Sep 9, 2015 Accepting new patients
Coastal Medical Associates CurrentSince Apr 1, 2020 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

115 Lincoln St
Framingham, MA 01702
Phone (508) 383-1000

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

141 Longwater Dr
Ste 201
Norwell, MA 02061
Phone (781) 261-7820

30 Perwal St
Westwood, MA 02090
Phone (781) 375-3308

55 Fogg Rd
#81
Weymouth, MA 02190

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1801200175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 FOGG RD",
            "city": "WEYMOUTH",
            "state": "MA",
            "postal_code": "021902432",
            "telephone_number": "781-624-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FOGG RD",
            "city": "WEYMOUTH",
            "state": "MA",
            "postal_code": "021902432",
            "telephone_number": "781-624-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPA",
        "first_name": "JENNIFER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-16",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "281275",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "281275",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN281275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weymouth, MA

Sources for this page

Verify at the official NPI Registry.