Individual provider Active NPI

Steve Crandall, PT

  • Physical Therapist
  • Grass Valley, CA
National Provider Identifier
1013356831
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 27297 Issued in CA
Practice address
130 W Berryhill Dr
Grass Valley, CA 95945-5835
Phone
(530) 205-9538
Fax
(530) 460-1841
NPI assigned
Jun 14, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 27297 CA Primary

Addresses

Primary practice location

130 W Berryhill Dr
Grass Valley, CA 95945-5835

Mailing address

130 W Berryhill Dr
Grass Valley, CA 95945-5835
Phone (530) 205-9538

Other practice location 1

11392 Pleasant Valley Rd
Penn Valley, CA 95946-9001
Phone (530) 432-9660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130824000107 CA Practitioner - Physical Therapist in Private Practice 5496707820 Reassigns benefits to 1 organization
Practice locations: Grass Valley, CA

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

130 W Berryhill Dr
Grass Valley, CA 95945-5835
Phone (530) 205-9538

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27297CAMDOral and Maxillofacial Surgery (Dentist)
PT 27297CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Wildwood Physical Therapy Inc CurrentSince Jul 17, 2013 Accepting new patients
New Edge Physical Therapy Inc Physical Therapist CurrentSince Oct 27, 2019 Accepting new patients
Evolution Physical Therapy & Wellness Physical Therapist CurrentSince Jan 1, 2021 Accepting new patients
Evolution Physical Therapy & Wellness LLC Physical Therapist PastSince Apr 1, 2019 Accepting new patients

Locations

130 W Berryhill Dr
Grass Valley, CA 95945
Phone (530) 205-9538

11392 Pleasant Valley Rd
Penn Valley, CA 95946
Phone (530) 432-9660

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1013356831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 W BERRYHILL DR",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455835",
            "telephone_number": "530-205-9538",
            "fax_number": "530-460-1841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W BERRYHILL DR",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455835",
            "telephone_number": "530-205-9538",
            "fax_number": "530-460-1841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11392 Pleasant Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Penn Valley",
            "state": "CA",
            "postal_code": "959469001",
            "country_code": "US",
            "telephone_number": "530-432-9660",
            "fax_number": "530-432-9663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRANDALL",
        "first_name": "STEVE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-14",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 27297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grass Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.