Individual provider Active NPI

Charlie Renee Crain

  • Community Health Worker
  • Orange, CA
National Provider Identifier
1134864002
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
1855 W Katella Ave Ste 150
Orange, CA 92867-3432
Phone
(714) 399-3480
NPI assigned
May 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X CA Primary

Addresses

Primary practice location

1855 W Katella Ave Ste 150
Orange, CA 92867-3432

Mailing address

1855 W Katella Ave Ste 150
Orange, CA 92867-3432
Phone (714) 399-3480

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL N/A

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

NPI Registry JSON

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1134864002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W KATELLA AVE STE 150",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928673432",
            "telephone_number": "714-399-3480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 W KATELLA AVE STE 150",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928673432",
            "telephone_number": "714-399-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAIN",
        "first_name": "CHARLIE",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-04",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "address_1": "419 Cedar Ave Apt C",
            "city": "Long Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "908026647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.