Individual provider Active NPI

Jason Champine, P.A.-C

  • Physician Assistant
  • Clinton Township, MI
National Provider Identifier
1902134430
Registry record updated Nov 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601002948 Issued in MI
Practice address
15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone
(586) 263-2193
NPI assigned
Nov 20, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601002948 MI Primary

Addresses

Primary practice location

15855 19 Mile Rd
Clinton Township, MI 48038-3504

Mailing address

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2193

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100423000058 MI Practitioner - Physician Assistant 7113054123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Macomb Hospital CorporationGroup PAC ID 7911808381, 349 clinicians

Practice addresses (Care Compare)

15717 15 Mile Rd
Clinton Township, MI 48035-2101

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2300

Hospital & facility affiliations

  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601002948MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Dec 2, 2015 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Dec 2, 2015 Accepting new patients

Locations

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

Interoperability endpoints

  • Direct secure messaging: jchampine10062@direct.hfhs.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1902134430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-263-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-263-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPINE",
        "first_name": "JASON",
        "credential": "P.A.-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.