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WALLACE JACKSON CHAMPLAIN DO
NPI 1689648636
Obstetrics & Gynecology in Tahlequah, OK

Active since February 15, 2006PECOS Enrolled
1500 E DOWNING ST STE 208, TAHLEQUAH, OK 74464(918) 456-2496(918) 456-7108 Get Directions Write a Review

NPPES record last updated: June 4, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wallace Jackson Champlain Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALLACE JACKSON CHAMPLAIN DO (NPI 1689648636) is an individual obstetrics & gynecology provider in Tahlequah, Oklahoma, licensed in Oklahoma (1994) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Hulbert.

NPPES Registry Identity

NPI1689648636
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameWALLACE JACKSON CHAMPLAINCredential: DO
Location Address1500 E DOWNING ST STE 208Tahlequah, OK 74464-3234
Mailing Address1500 E Downing Suite 208Tahlequah, OK 74464-3363 · (918) 456-2496 · Fax (918) 456-7108
Phone(918) 456-2496
Fax(918) 456-7108
Sole ProprietorNo
Enumeration DateFebruary 15, 2006
Last NPPES UpdateJune 4, 2019
✔ NPI 1689648636 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License✔ Licensed in OK · 1994
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
1500 E DOWNING ST STE 208, Tahlequah, OK 74464
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Secondary Practice Location 1

Location 1127 E MainHulbert, OK 74441 · Phone (918) 772-3390 · Fax (918) 772-3638

Other Identifiers 1

Medicaid100118860AOK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Oklahoma, CommunityCare, Medica and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wallace Jackson Champlain Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 74464 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$123.06 typical visit price
range $53.00 – $162.61
Typical copayment $30.76 (range $13.25 – $40.65)
Most-billed visit code 99204
Established Patient
$66.48 typical visit price
range $16.68 – $132.40
Typical copayment $16.62 (range $4.17 – $33.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TSCHANTRE EUJEANIA DORSETT MD
Obstetrics & Gynecology
1500 E DOWNING ST STE 208
TAHLEQUAH, OK 74464
Cherokee County (918) 456-2496
DR. ERIC WILLIAM SIMONS MD
Obstetrics & Gynecology
1500 E DOWNING ST STE 208
TAHLEQUAH, OK 74464
Cherokee County (918) 456-2496
MR. JOHN RICHARD DOSS M.D.
Obstetrics & Gynecology
1500 E DOWNING ST STE 208
TAHLEQUAH, OK 74464
Cherokee County (918) 456-2496

Frequently 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 Wallace Champlain's NPI number?

The NPI number for Wallace Champlain is 1689648636. It was assigned to this individual provider in the NPPES registry on February 15, 2006.

Where is Wallace Champlain located?

Wallace Champlain practices at 1500 E Downing St Ste 208, Tahlequah, OK 74464. The listed phone number is (918) 456-2496.

What is Wallace Champlain's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Wallace Champlain enrolled in Medicare?

Yes. Wallace Champlain is registered in the Medicare PECOS enrollment system.

What insurance does Wallace Champlain accept?

Health plans from Blue Cross and Blue Shield of Oklahoma, CommunityCare, Medica and Mending Health list Wallace Champlain as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wallace Champlain was last updated on June 4, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.