Individual provider Active NPI

Matthew Champ

  • Professional Counselor
  • Saint Paul, MN
National Provider Identifier
1861341430
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
05358 Issued in MN
Practice address
771 Raymond Ave
Saint Paul, MN 55114-1522
Phone
(651) 243-2292
NPI assigned
Jan 26, 2026
Last updated
Jan 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 05358 MN Primary

Addresses

Primary practice location

771 Raymond Ave
Saint Paul, MN 55114-1522

Mailing address

771 Raymond Ave
Saint Paul, MN 55114-1522
Phone (651) 243-2292

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260206001236 MN Practitioner - Mental Health Counselor 4486133840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

771 Raymond Ave
Saint Paul, MN 55114-1522

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05358MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Oliver Ross Psychology and Consulting LLC CurrentSince Jan 29, 2026 Accepting new patients

Locations

771 Raymond Ave
Saint Paul, MN 55114
Phone (612) 235-6743

Organizations & group practices 1

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": "1769385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1861341430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 RAYMOND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141522",
            "telephone_number": "651-243-2292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 RAYMOND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141522",
            "telephone_number": "651-243-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMP",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-01-26",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "05358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.