Crystal D Faudere, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

530512 Issued in KS

Practice address

700 W Central Ave
Suite 205
El Dorado, KS 67042-2184

Phone

(316) 321-2010

Fax

(316) 321-8871

NPI assigned

Jan 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

El Dorado Clinic, P.a.Group PAC ID 7911944897, 6 clinicians

Susan B Allen Memorial HospitalGroup PAC ID 7719898980, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Susan B Allen Mem Hospital HHA Home health agency, El Dorado, KS, CCN 177053
• Specialized Home Care Home health agency, Wichita, KS, CCN 178111
• Phoenix Home Care Home health agency, Wichita, KS, CCN 178012
• Interim Healthcare of Wichita Inc (Hospice) Hospice, Wichita, KS, CCN 171576
• Susan B Allen Memorial Hospital Hospital, El Dorado, KS, CCN 170017

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crystal.faudere@khindirect.org
• Direct secure messaging: drfaudere@eldoradoclinic.azalea.phimailbox.com
• Direct secure messaging: crystal.faudere@directsbamh.org

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• El Dorado Clinic, P.a.

  • Rural Health Clinic/Center
  • El Dorado, KS
  • NPI 1780787176

  5% Or Greater Direct Ownership Interest, Corporate Officer

  CMS ownership

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.

• El Dorado Clinic, P.a.

  • Family Medicine Physician
  • El Dorado, KS
  • NPI 1770559767
  Medicare reassignment Care Compare group NPD
• Susan B. Allen Memorial Hospital

  • General Practice Physician
  • El Dorado, KS
  • NPI 1164554820
  Medicare reassignment Care Compare group NPD
• El Dorado Clinic, P.a.

  • Rural Health Clinic/Center
  • El Dorado, KS
  • NPI 1780787176

  Family Medicine

  NPD
• Susan B. Allen Memorial Hospital

  • General Acute Care Hospital
  • El Dorado, KS
  • NPI 1700994977
  NPD (past)

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

• Core Home Health Agency LLC

  • Home Health Agency
  • Wichita, KS
  • NPI 1194493569
  Care Compare affiliation
• Interim Health Care of Wichita Inc

  • Community Based Hospice Care Agency
  • Wichita, KS
  • NPI 1215252499
  Care Compare affiliation
• Proactive Home Care, LLC

  • Home Health Agency
  • Wichita, KS
  • NPI 1013979905
  Care Compare affiliation
• Susan B Allen Memorial Hospital

  • Home Health Agency
  • El Dorado, KS
  • NPI 1538262894
  Care Compare affiliation
• Susan B. Allen Memorial Hospital

  • General Acute Care Hospital
  • El Dorado, KS
  • NPI 1700994977
  Care Compare affiliation

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270684800000",
    "number": "1083685291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W CENTRAL AVE",
            "address_2": "SUITE 205",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422184",
            "telephone_number": "316-321-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W CENTRAL AVE",
            "address_2": "SUITE 205",
            "city": "EL DORADO",
            "state": "KS",
            "postal_code": "670422184",
            "telephone_number": "316-321-2010",
            "fax_number": "316-321-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUDERE",
        "first_name": "CRYSTAL",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "530512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200331140A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in El Dorado, KS
• Providers in El Dorado, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.