Active NPI
Crystal Middleton, RD
- Registered Dietitian
- Saint Louis, MO
National Provider Identifier
1093450116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164005204
- Practice address
- 1 Jefferson Barracks Dr
Saint Louis, MO 63125-4181 - Phone
- (314) 652-4100
- NPI assigned
- May 3, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164005204 | IL | Primary |
Addresses
Primary practice location
1 Jefferson Barracks Dr
Saint Louis, MO 63125-4181
Mailing address
1325 Centerpoint Cir Apt 203
Shiloh, IL 62269-2170
Phone (618) 201-1432
Other practice location 1
1325 Centerpoint Cir Apt 203
Shiloh, IL 62269-2170
Phone (618) 201-1432
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164005204 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713744000000",
"number": "1093450116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 CENTERPOINT CIR APT 203",
"city": "SHILOH",
"state": "IL",
"postal_code": "622692170",
"telephone_number": "618-201-1432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 JEFFERSON BARRACKS DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631254181",
"telephone_number": "314-652-4100"
}
],
"practiceLocations": [
{
"address_1": "1325 Centerpoint Cir Apt 203",
"address_purpose": "LOCATION",
"city": "Shiloh",
"state": "IL",
"postal_code": "622692170",
"country_code": "US",
"telephone_number": "618-201-1432",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIDDLETON",
"first_name": "CRYSTAL",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-03",
"last_updated": "2024-04-22",
"certification_date": "2024-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164005204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.