Individual provider Active NPI

Cornelis Kirk Craye, MD

  • Internal Medicine Physician
  • Roanoke, VA
National Provider Identifier
1083680508
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101237947 Issued in VA
Practice address
1111 S Jefferson St Ste B
Roanoke, VA 24016-4724
Phone
(540) 345-3556
Fax
(540) 342-2193
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35.09333 OH
Internal Medicine Physician 207R00000X 0101237947 VA Primary

Addresses

Primary practice location

1111 S Jefferson St Ste B
Roanoke, VA 24016-4724

Mailing address

PO Box 8310
Roanoke, VA 24014-0310
Phone (540) 345-3556

Other identifiers 1

IdentifierTypeStateIssuer
2999377MedicaidOH

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.09333OHMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1083680508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8310",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240140310",
            "telephone_number": "540-345-3556",
            "fax_number": "540-342-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S JEFFERSON ST STE B",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164724",
            "telephone_number": "540-345-3556",
            "fax_number": "540-342-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAYE",
        "first_name": "CORNELIS",
        "middle_name": "KIRK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.09333",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101237947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2999377",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.