Individual provider Active NPI

Jeffrey John Crittenden, MD

  • Gastroenterology Physician
  • Dothan, AL
National Provider Identifier
1043264336
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
12796 Issued in AL
Practice address
480 Honeysuckle Rd
Dothan, AL 36305-1156
Phone
(334) 836-1212
Fax
(334) 836-1888
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 12796 AL Primary

Addresses

Primary practice location

480 Honeysuckle Rd
Dothan, AL 36305-1156

Mailing address

480 Honeysuckle Rd
Dothan, AL 36305-1156
Phone (334) 836-1212

Other identifiers 3

IdentifierTypeStateIssuer
P00233449OtherRAILROAD MEDICARE
00425708AMedicaidGA
1202092OtherUNITED HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050711000796 AL Practitioner - GastroenterologyPractitioner - Internal Medicine 7517944556 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12796ALMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gut PC CurrentSince Aug 1, 2005 Accepting new patients
Gut PC Gastroenterology CurrentSince Aug 1, 2005 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

265 Medical Park Blvd
Dothan, AL 36301
Phone (334) 305-0112

480 Honeysuckle Rd
Dothan, AL 36305
Phone (334) 792-6933

614 N Main St
Ste A
Enterprise, AL 36330
Phone (334) 489-4244

Organizations & group practices 3

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043264336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 HONEYSUCKLE RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051156",
            "telephone_number": "334-836-1212",
            "fax_number": "334-836-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 HONEYSUCKLE RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051156",
            "telephone_number": "334-836-1212",
            "fax_number": "334-836-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRITTENDEN",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AL",
            "license": "12796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00233449",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00425708A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1202092",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.