WALLACE JACKSON CHAMPLAIN DO
NPI 1689648636
Obstetrics & Gynecology in Tahlequah, OK
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
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wallace Jackson Champlain Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Wallace Champlain reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Tahlequah, OK 74464
- Reassigned Medicare billing, Oklahoma enrollment
- 65 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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.
Which organization bills Medicare for Wallace Champlain's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Wallace Champlain reassigns Medicare benefits to Northeastern Oklahoma Community Health Centers, Inc. (Tahlequah, OK). The 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 Wallace Champlain's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Wallace Champlain accept?
Health plans from CommunityCare 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.
# Wallace Jackson Champlain, DO · NPI 1689648636
Obstetrics & Gynecology physician in Tahlequah, Oklahoma. Individual provider, active in the CMS NPPES registry since February 15, 2006.
## Identity
- **NPI:** 1689648636 (Entity type: Individual)
- **Enumerated:** February 15, 2006
- **Primary specialty:** Obstetrics & Gynecology · taxonomy 207V00000X
- **State license:** 1994 (Oklahoma)
- **Sole proprietor:** No
## Practice location
- **Address:** 1500 E DOWNING ST STE 208, Tahlequah, OK 74464-3234
- **Phone:** (918) 456-2496 · **Fax:** (918) 456-7108
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Northeastern Oklahoma Community Health Centers, Inc. (NPI 1063188878, Tahlequah, OK), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 4, 2019
- **Other identifiers:** Medicaid 100118860A (OK)
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Source: [NPI Profile](https://npiprofile.com/npi/1689648636) · Data from the CMS NPPES public registry.