Individual provider Active NPI

Charles A Crump Jr., MD

  • Internal Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1093704744
Registry record updated Dec 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
26232 Issued in TN
Practice address
2205 McCallie Ave
Chattanooga, TN 37404-3323
Phone
(423) 698-2435
Fax
(423) 697-6110
NPI assigned
Oct 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 26232 TN Primary

Addresses

Primary practice location

2205 McCallie Ave
Chattanooga, TN 37404-3323

Mailing address

2205 McCallie Ave
Chattanooga, TN 37404-3323
Phone (423) 698-2435

Other identifiers 1

IdentifierTypeStateIssuer
38023241MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20071009000891 TN Practitioner - Internal Medicine 4981790797 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26232TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Diagnostic Imaging, PC Internal Medicine CurrentSince Jun 14, 2022 Accepting new patients
Advanced Diagnostic Imaging PC CurrentSince Jun 14, 2022 Accepting new patients

Locations

3024 Business Park Cir
Goodlettsvlle, TN 37072
Phone (615) 239-2018

3443 Dickerson Pike
Ste 400
Nashville, TN 37207
Phone (615) 612-2146

Interoperability endpoints

  • Direct secure messaging: charles.crump@ahp.eclinicaldirectplus.com

Organizations & group practices 2

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": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197676800000",
    "number": "1093704744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 MCCALLIE AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374043323",
            "telephone_number": "423-698-2435",
            "fax_number": "423-697-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 MCCALLIE AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374043323",
            "telephone_number": "423-698-2435",
            "fax_number": "423-697-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMP",
        "first_name": "CHARLES",
        "middle_name": "A",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2007-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "26232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38023241",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.