Active NPI
Christian Jose Nunez, MD
- Pediatrics Physician
- Fort Campbell, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 26625
- Practice address
- 650 Joel Dr
Fort Campbell, KY 42223-5318 - Phone
- (270) 798-8400
- NPI assigned
- Apr 15, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2016016499 | MO | |
| Pediatrics Physician | 208000000X | 57914 | TN | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 2016016499 | MO | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 57914 | TN | |
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | 26625 | MS | |
| Hospitalist Physician | 208M00000X | 2016016499 | MO | |
| Pediatrics Physician | 208000000X | 26625 | MS | Primary |
Addresses
Primary practice location
650 Joel Dr
Fort Campbell, KY 42223-5318
Mailing address
1555 Raven Rd
Clarksville, TN 37042-8199
Phone (816) 876-4480
Other practice location 1
1100 Belk Blvd
Oxford, MS 38655-5242
Phone (662) 636-1090
Other practice location 2
1 Childrens Pl
Saint Louis, MO 63110-1002
Phone (314) 454-2076
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ENROLLED | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57914 | TN | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington University | Current | Accepting new patients | |
| Washington University | Current | Accepting new patients |
Locations
1 Childrens Pl
#8116
Saint Louis, MO 63110
Phone (314) 454-6095
1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104
1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076
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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Saint Louis, MO
- NPI 1194765685
-
- Multi-Specialty Clinic/Center
- Saint Louis, MO
- NPI 1962442475
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708128000000",
"number": "1831532332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1555 RAVEN RD",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370428199",
"telephone_number": "816-876-4480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-798-8400"
}
],
"practiceLocations": [
{
"address_1": "1100 Belk Blvd",
"address_purpose": "LOCATION",
"city": "Oxford",
"state": "MS",
"postal_code": "386555242",
"country_code": "US",
"telephone_number": "662-636-1090",
"fax_number": "662-636-1676",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Childrens Pl",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631101002",
"country_code": "US",
"telephone_number": "314-454-2076",
"fax_number": "314-747-8953",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NUNEZ",
"first_name": "CHRISTIAN",
"middle_name": "JOSE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-15",
"last_updated": "2024-02-17",
"certification_date": "2024-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2016016499",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "57914",
"primary": false
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "MO",
"license": "2016016499",
"primary": false
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "TN",
"license": "57914",
"primary": false
},
{
"code": "2080P0204X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Emergency Medicine",
"state": "MS",
"license": "26625",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MO",
"license": "2016016499",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MS",
"license": "26625",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.