Individual provider Active NPI

Matthew David Crookston, O.D.

  • Optometrist
  • League City, TX
National Provider Identifier
1083654701
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5719TG Issued in TX
Practice address
2103 Pleasant Valley Dr
League City, TX 77573-4430
Phone
(713) 894-7104
NPI assigned
Jun 8, 2006
Last updated
Feb 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5719TG TX Primary

Addresses

Primary practice location

2103 Pleasant Valley Dr
League City, TX 77573-4430

Mailing address

301 University Blvd
Galveston, TX 77555-5302
Phone (409) 772-2222

Other identifiers 3

IdentifierTypeStateIssuer
7070163OtherTXAETNA
038639301MedicaidTX
410046076OtherTXRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101020001468 TX Practitioner - Optometry 6800089046 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

10121 Emmett F Lowry Expy
Texas City, TX 77591-2286
Phone (409) 986-9686

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.88 of 100Reported as group
Quality
73.38
Improvement activities
40
Cost
78.42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5719TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice CurrentSince Jun 21, 2014 Accepting new patients

Locations

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

301 University Blvd
Fl 6
Galveston, TX 77555

700 University Blvd
Galveston, TX 77550
Phone (281) 338-0829

511 Park Grove Dr
Katy, TX 77450
Phone (281) 398-7001

10121 Emmett F Lowry Expy
Texas City, TX 77591
Phone (409) 938-8466

200 Blossom St
Webster, TX 77598
Phone (281) 525-7000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581465600000",
    "number": "1083654701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775555302",
            "telephone_number": "409-772-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 PLEASANT VALLEY DR",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775734430",
            "telephone_number": "713-894-7104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROOKSTON",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5719TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7070163",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038639301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410046076",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in League City, TX

Sources for this page

Verify at the official NPI Registry.