Individual provider Active NPI

Kirsten Crawford, PHYSICIAN ASSISTANT

  • Physician Assistant
  • East Lansing, MI
National Provider Identifier
1114683588
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601010820 Issued in MI
Practice address
2852 Eyde Pkwy
East Lansing, MI 48823-6817
Phone
(517) 333-4600
NPI assigned
Nov 10, 2021
Last updated
Jan 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601010820 MI Primary

Addresses

Primary practice location

2852 Eyde Pkwy
East Lansing, MI 48823-6817

Mailing address

3814 Camelot Dr SE Apt 2B
Grand Rapids, MI 49546-6046

Other practice location 1

522 Leonard St NW
Grand Rapids, MI 49504-4258
Phone (616) 451-8868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211217000397 MI Practitioner - Physician Assistant 0244621787 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boyne Country Urgent Care PCGroup PAC ID 3173565850, 4 clinicians

Practice addresses (Care Compare)

1951 S Ostego Ave
Gaylord, MI 49735-8489

1951 S Otsego Ave
Up North Medical Center
Gaylord, MI 49735-8489
Phone (989) 732-3284

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sams Physical Therapy PC Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1114683588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3814 CAMELOT DR SE APT 2B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 EYDE PKWY",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488236817",
            "telephone_number": "517-333-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "522 Leonard St NW",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495044258",
            "country_code": "US",
            "telephone_number": "616-451-8868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRAWFORD",
        "first_name": "KIRSTEN",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-10",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601010820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.