NPIMap

Organization Active NPI

Neogenesis Nutrition Inc

  • Health Service Clinic/Center
  • University Place, WA
National Provider Identifier
1861191868
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
NEOGENESIS NUTRITION INC
Practice address
7018 59TH Street CT W
University Place, WA 98467-2172
Phone
(253) 507-5775
NPI assigned
Feb 28, 2023
Last updated
Nov 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Authorized official

Name
Dr. Jennifer Champion, DCN, MS, CNS, CN, LDNPI 1275055865
Title
Owner
Phone
(253) 507-5775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary

Addresses

Primary practice location

7018 59TH Street CT W
University Place, WA 98467-2172

Mailing address

7018 59TH Street CT W
University Place, WA 98467-2172
Phone (253) 507-5775

Other practice location 1

2607 Bridgeport Way W Ste 2M
University Place, WA 98466-4725
Phone (253) 507-5775

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251126002796 WA Part B Supplier - Clinic/Group Practice 1355833294 Receives reassigned benefits from 1 practitioner
Practice locations: University Place, WA

National Provider Directory

National Provider Directory

Locations

2607 Bridgeport Way W
Ste 2M
University Place, WA 98466
Phone (253) 507-5775

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762300800000",
    "number": "1861191868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7018 59TH STREET CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984672172",
            "telephone_number": "253-507-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7018 59TH STREET CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984672172",
            "telephone_number": "253-507-5775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2607 Bridgeport Way W Ste 2M",
            "address_purpose": "LOCATION",
            "city": "University Place",
            "state": "WA",
            "postal_code": "984664725",
            "country_code": "US",
            "telephone_number": "253-507-5775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEOGENESIS NUTRITION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-28",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A",
        "authorized_official_last_name": "CHAMPION",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-507-5775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DCN, MS, CNS, CN, LD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.