Active NPI
Jeffrey John Crittenden, MD
- Gastroenterology Physician
- Dothan, AL
National Provider Identifier
1043264336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 12796
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00233449 | Other | RAILROAD MEDICARE | |
| 00425708A | Medicaid | GA | |
| 1202092 | Other | UNITED 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12796 | AL | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gut PC | Current | Accepting new patients | |
| Gut PC | Gastroenterology | Current | 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.
-
- Gastroenterology Physician
- Dothan, AL
- NPI 1073566006
-
- Anesthesiology Physician
- Dothan, AL
- NPI 1790201903
-
- Multi-Specialty Clinic/Center
- Bainbridge, GA
- NPI 1053388256
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.