Active NPI
Raymond Charles Croissant, MD
- Ophthalmology Physician
- Edina, MN
National Provider Identifier
1083698419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 19945
- Practice address
- 6533 Drew Ave S
Edina, MN 55435-2103 - Phone
- (952) 927-7138
- Fax
- (952) 924-4021
- NPI assigned
- Nov 30, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 19945 | MN | Primary |
Addresses
Primary practice location
6533 Drew Ave S
Edina, MN 55435-2103
Mailing address
6533 Drew Ave S
Edina, MN 55435-2103
Phone (952) 927-7138
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 166865000 | Medicaid | MN |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 19945 | MN | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319414400000",
"number": "1083698419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6533 DREW AVE S",
"city": "EDINA",
"state": "MN",
"postal_code": "554352103",
"telephone_number": "952-927-7138",
"fax_number": "952-924-4021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6533 DREW AVE S",
"city": "EDINA",
"state": "MN",
"postal_code": "554352103",
"telephone_number": "952-927-7138",
"fax_number": "952-924-4021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROISSANT",
"first_name": "RAYMOND",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-30",
"last_updated": "2011-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MN",
"license": "19945",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "166865000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.