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JOHANNA E CHAMPAGNE LLC
Complete NPI Record 1215383690
Counselor - Professional in Royal Oak, MI

NPI Status: Active since May 04, 2016

Contact Information

1103 S WASHINGTON AVE
ROYAL OAK, MI
ZIP 48067
Phone: (248) 518-0018

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Is Organization Subpart
  28. Authorized Official Credential Text
  29. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1215383690. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1215383690
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 1103 S WASHINGTON AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: ROYAL OAK
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MI
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 480673219
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 2485180018
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider First Line Business Practice Location Address: 1103 S WASHINGTON AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ROYAL OAK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MI
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 480673219
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2485180018
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/4/2016
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/4/2016
The date that a record was last updated or changed.
Authorized Official Last Name: CHAMPAGNE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: JOHANNA
The first name of the authorized official.
Authorized Official Title or Position: OWNER / AUTHORIZED OFFICIAL
The title or position of the authorized official.
Authorized Official Telephone Number: 2485180018
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 101YP2500X
This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 6401013115
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider License Number State Code 1: MI
The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
Healthcare Provider Primary Taxonomy Switch 1: Y
This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Is Organization Subpart: N
Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Authorized Official Credential Text: LPC
The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.