Crystal Bastin MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20368 Issued in WV

Legal business name

CRYSTAL BASTIN MD LLC

Practice address

4820 Kentucky St
South Charleston, WV 25309-1310

Phone

(304) 720-0390

NPI assigned

Apr 23, 2007

Last updated

Nov 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shannon G Davis

Title

Office Manager

Phone

(304) 720-0390

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384214400000",
    "number": "1053539387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4820 KENTUCKY STREET",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091364",
            "telephone_number": "304-720-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4820 KENTUCKY ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091310",
            "telephone_number": "304-720-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL BASTIN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2013-11-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "304-720-0390"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "20368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801865001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Makayla Morgan Crouch
• Max Crow III
• Kaylee Jo Crowder, PRSS-SUD
• Charlene Crum
• Heather Crum
• Wendell Craig Culbertson
• Ashley Nicole Cumberledge, PA-C
• Angela Cunningham
• Cassy Cunningham
• Rah'Keijah Cunningham

• Family Medicine Physician in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.