NPIMap

Organization Active NPI

Champion Performance Physical Therapy, PC

  • Physical Therapist
  • Austin, TX
National Provider Identifier
1942279823
Registry record updated Jul 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
656610000 Issued in TX
Legal business name
CHAMPION PERFORMANCE PHYSICAL THERAPY, PC
Practice address
12611 Hymeadow Dr
Austin, TX 78729-2700
Phone
(512) 996-0441
Fax
(512) 996-0442
NPI assigned
Mar 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2010

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

Authorized official

Name
Christie Jean Powell, MSPTNPI 1134154883
Title
Owner, Physical Therapist
Phone
(512) 996-0441

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 656610000 TX Primary

Addresses

Primary practice location

12611 Hymeadow Dr
Austin, TX 78729-2700

Mailing address

PO Box 170040
Austin, TX 78717-0003
Phone (512) 996-0441

Other identifiers 3

IdentifierTypeStateIssuer
3418380OtherTXCIGNA
0045MROtherTXBC/BS PROVIDER NUMBER
7141718OtherTXAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060725000161 TX Part B Supplier - Clinic/Group Practice 1153334834 Receives reassigned benefits from 12 practitioners
Practice locations: Cedar Park, TX

National Provider Directory

National Provider Directory

Locations

12325 Hymeadow Dr
Ste 3-100
Austin, TX 78750

139 E Saint Elmo Rd
Ste 101
Austin, TX 78745

12611 Hymeadow Dr
Austin, TX 78729

1220 Toro Grande Dr
Cedar Park, TX 78613

12617 Ridgeline Blvd
Bldg C105
Cedar Park, TX 78613

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1942279823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 170040",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787170003",
            "telephone_number": "512-996-0441",
            "fax_number": "512-996-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12611 HYMEADOW DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787292700",
            "telephone_number": "512-996-0441",
            "fax_number": "512-996-0442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION PERFORMANCE PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "512-996-0441",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "656610000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3418380",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "0045MR",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7141718",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; 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.