Individual provider Active NPI

Patricia P Champion

  • Optometrist
  • Brevard, NC
National Provider Identifier
1811933401
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1541 Issued in NC
Practice address
188 Medical Park Dr Ste C
Brevard, NC 28712-4188
Phone
(828) 884-7320
NPI assigned
Jun 21, 2006
Last updated
Nov 5, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1541 NC Primary

Addresses

Primary practice location

188 Medical Park Dr Ste C
Brevard, NC 28712-4188

Mailing address

188 Medical Park Dr Ste C
Brevard, NC 28712-4188
Phone (828) 884-7320

Other identifiers 6

IdentifierTypeStateIssuer
2271058OtherNCUNITED HEALTHCARE
NC01541OtherNCVISION BENEFITS OF AMERIC
114419OtherNCEYEMED
890911XMedicaidNC
1329153OtherNCCIGNA
10716OtherNCBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071024000650 NC Practitioner - Optometry 4688775679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Looking Glass Eye Center P aGroup PAC ID 6901889617, 5 clinicians

Practice addresses (Care Compare)

188 Medical Park Dr
Suite C
Brevard, NC 28712-4188
Phone (828) 884-7320

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1541NCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Looking Glass Eye Center PA Optometrist CurrentSince May 1, 2019 Accepting new patients
Looking Glass Eye Center P a Optometrist CurrentSince May 1, 2019 Accepting new patients

Locations

188 Medical Park Dr
Ste C
Brevard, NC 28712
Phone (828) 884-7320

215 Thompson St
Hendersonvlle, NC 28792
Phone (828) 693-4161

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1811933401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 MEDICAL PARK DR STE C",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287124188",
            "telephone_number": "828-884-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 MEDICAL PARK DR STE C",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287124188",
            "telephone_number": "828-884-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "PATRICIA",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2271058",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION BENEFITS OF AMERIC",
            "identifier": "NC01541",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "114419",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890911X",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1329153",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10716",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brevard, NC

Sources for this page

Verify at the official NPI Registry.