Crescent Medical PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

115662 Issued in NY

Legal business name

CRESCENT MEDICAL PC

Practice address

10825 Merrick Blvd
Jamaica, NY 11433-2906

Phone

(718) 658-9700

Fax

(718) 658-9703

NPI assigned

Apr 19, 2016

Organization subpart

No

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

Authorized official

Name

Samuel Roy Walters, MD

Title

Owner

Phone

(718) 658-9700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1063866838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10825 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332906",
            "telephone_number": "718-658-9700",
            "fax_number": "718-658-9703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10825 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332906",
            "telephone_number": "718-658-9700",
            "fax_number": "718-658-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-658-9700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "115662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2016; 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.