Active NPI
Crystal R Dininger, PA
- Physician Assistant
- Atlanta, GA
National Provider Identifier
1073785366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1669
- Practice address
- 960 Johnson Ferry Rd
Ste 100
Atlanta, GA 30342-1631 - Phone
- (404) 252-9063
- Fax
- (404) 252-0873
- NPI assigned
- Mar 27, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1669 | GA | Primary |
Addresses
Primary practice location
960 Johnson Ferry Rd
Ste 100
Atlanta, GA 30342-1631
Mailing address
960 Johnson Ferry Rd
Ste 100
Atlanta, GA 30342-1631
Phone (404) 252-9063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003135882A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1669 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlanta Cardiac & Thoracic Surgery | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Atlanta, GA
- NPI 1376753970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485302400000",
"number": "1073785366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 JOHNSON FERRY RD",
"address_2": "STE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421631",
"telephone_number": "404-252-9063",
"fax_number": "404-252-0873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 JOHNSON FERRY RD",
"address_2": "STE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421631",
"telephone_number": "404-252-9063",
"fax_number": "404-252-0873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DININGER",
"first_name": "CRYSTAL",
"middle_name": "R",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-27",
"last_updated": "2017-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "1669",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003135882A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.