Wallace Jackson Champlain, DO - Medicare Obstetrics & Gynecology in Tahlequah, OK

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Wallace Jackson Champlain, DO is a medicare enrolled "Obstetrics & Gynecology" physician in Tahlequah, Oklahoma. His current practice location is 1500 E Downing St Ste 208, Tahlequah, Oklahoma. You can reach out to his office (for appointments etc.) via phone at (918) 456-2496.

Wallace Jackson Champlain is licensed to practice in Oklahoma (license number 1994) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1689648636.

Contact Information

Wallace Jackson Champlain, DO
1500 E Downing St Ste 208,
Tahlequah, OK 74464-3234
(918) 456-2496
(918) 456-7108

Map and Direction




Physician's Profile

Full NameWallace Jackson Champlain
GenderMale
SpecialityObstetrics & Gynecology
Location1500 E Downing St Ste 208, Tahlequah, Oklahoma
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1689648636
  • Provider Enumeration Date: 02/15/2006
  • Last Update Date: 06/04/2019
  Medicare PECOS Information:
  • PECOS PAC ID: 8527059328
  • Enrollment ID: I20040520000836

Medical Identifiers

Medical identifiers for Wallace Jackson Champlain such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1689648636NPI-NPPES
100118860AMedicaidOK

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207V00000XObstetrics & Gynecology 1994 (Oklahoma)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Wallace Jackson Champlain allows following entities to bill medicare on his behalf.
Entity NameNortheastern Oklahoma Community Health Centers, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1518070481
PECOS PAC ID: 3678482635
Enrollment ID: O20031104000417

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Wallace Jackson Champlain is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Wallace Jackson Champlain, DO
1500 E Downing Suite 208,
Tahlequah, OK 74464-3363

Ph: (918) 456-2496		Wallace Jackson Champlain, DO
1500 E Downing St Ste 208,
Tahlequah, OK 74464-3234

Ph: (918) 456-2496

Reviews and Comments


Obstetrics & Gynecology Doctors in Tahlequah, OK

Miranda Dawn Knight-brown, M.D.
Obstetrics & Gynecology
Medicare: Accepting Medicare Assignments
Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464
Phone: 918-458-3100    Fax: 918-458-3610
Dr. Kayla Jeanne Cagle-colon, M.D.
Obstetrics & Gynecology
Medicare: Accepting Medicare Assignments
Practice Location: 1500 E Downing St Ste 214, Tahlequah, OK 74464
Phone: 918-431-0202    
Lana Dawn Myers, D.O.
Obstetrics & Gynecology
Medicare: Medicare Enrolled
Practice Location: 1201 East Ross Bypass, Tahlequah, OK 74464
Phone: 918-207-0991    Fax: 918-456-7570
Dr. David Richard Gahn, MD
Obstetrics & Gynecology
Medicare: Accepting Medicare Assignments
Practice Location: 100 S Bliss Ave, Hastings Indian Medical Center, Tahlequah, OK 74464
Phone: 918-458-3360    Fax: 918-458-3315
Dr. Greggory Jon Woitte, MD
Obstetrics & Gynecology
Medicare: Not Enrolled in Medicare
Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464
Phone: 918-458-3130    Fax: 918-458-3315
Tschantre Eujeania Dorsett, MD
Obstetrics & Gynecology
Medicare: Accepting Medicare Assignments
Practice Location: 1500 E Downing St Ste 208, Tahlequah, OK 74464
Phone: 918-456-2496    Fax: 918-456-7108

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.