CHAMPION MEDICAL CARE LLC
NPI 1396606265
Family Medicine in Shelbyville, TN
About Champion Medical Care Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CHAMPION MEDICAL CARE LLC (NPI 1396606265) is a healthcare organization registered as a family medicine in Shelbyville, Tennessee and active in the NPI registry since November 2025. The organization holds a CLIA Waiver certificate valid through February 1, 2028 and lists John Mason Douglas, Np/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Champion Medical Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Champion Medical Care LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 44D2337912
Champion Medical Care LLC · Shelbyville, TNFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Champion Medical Care LLC's NPI number?
The NPI number for Champion Medical Care LLC is 1396606265. It was assigned to this organization in the NPPES registry on November 20, 2025.
Where is Champion Medical Care LLC located?
Champion Medical Care LLC is located at 1114 N Main St Ste A, Shelbyville, TN 37160. The listed phone number is (931) 652-9369.
What is Champion Medical Care LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Champion Medical Care LLC enrolled in Medicare?
Yes. Champion Medical Care LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Champion Medical Care LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Champion Medical Care LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Champion Medical Care LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 44D2337912) is associated with this NPI, valid through February 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Champion Medical Care LLC was last updated on November 20, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Champion Medical Care Llc · NPI 1396606265
Family Medicine organization in Shelbyville, Tennessee. Organization record, active in the CMS NPPES registry since November 20, 2025.
## Identity
- **NPI:** 1396606265 (Entity type: Organization)
- **Enumerated:** November 20, 2025
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** John Douglas, NP/OWNER
## Practice location
- **Address:** 1114 N MAIN ST STE A, Shelbyville, TN 37160-2380
- **Phone:** (931) 652-9369
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 20, 2025
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1396606265) · Data from the CMS NPPES public registry.