NPIMap

Individual provider Active NPI

Mary Ann Crumlish, PA-C

  • Medical Physician Assistant
  • Gulf Breeze, FL
National Provider Identifier
1053361956
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9102271 Issued in FL
Practice address
2744 Gulf Breeze Parkway
Gulf Breeze, FL 32563-2908
Phone
(850) 934-5713
Fax
(850) 934-0379
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9102271 FL Primary

Addresses

Primary practice location

2744 Gulf Breeze Parkway
Gulf Breeze, FL 32563-2908

Mailing address

2744 Gulf Breeze Parkway
Gulf Breeze, FL 32563-3091
Phone (850) 934-5713

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040604000548 FL Practitioner - Physician Assistant 5597747394 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9102271FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Robert a. Norman, D.O., P.a. Past Accepting new patients
Avenir Ventures, L.L.C. Past Accepting new patients
Comfort Care Medical Group PA Medical Past Accepting new patients
Veterans National Homecare Inc Past Accepting new patients
Avenir Ventures, L.L.C. PastSince Jun 1, 2012 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mary.crumlish.1@30358.direct.athenahealth.com

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1053361956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2744 GULF BREEZE PARKWAY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325633091",
            "telephone_number": "850-934-5713",
            "fax_number": "850-934-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2744 GULF BREEZE PARKWAY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325632908",
            "telephone_number": "850-934-5713",
            "fax_number": "850-934-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMLISH",
        "first_name": "MARY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9102271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulf Breeze, FL

Sources for this page

Verify at the official NPI Registry.