Individual provider Active NPI

Christian Jose Nunez, MD

  • Pediatrics Physician
  • Fort Campbell, KY
National Provider Identifier
1831532332
Registry record updated Feb 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
26625 Issued in MS
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

Updated by the provider on Feb 17, 2024

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
ENROLLEDMedicaidIL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160811001348 MO Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 1254573637 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
57914TNMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jul 3, 2016 Accepting new patients
Washington University CurrentSince Jul 3, 2016 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.

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

Verify at the official NPI Registry.