NPIMap

Individual provider Active NPI

Crescenzo Pisano, M.D.

  • Internal Medicine Physician
  • San Pedro, CA
National Provider Identifier
1144336769
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G42081 Issued in CA
Practice address
1499 W 1St St
San Pedro, CA 90732-3255
Phone
(310) 831-9482
Fax
(310) 831-1230
NPI assigned
Aug 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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 G42081 CA Primary

Addresses

Primary practice location

1499 W 1St St
San Pedro, CA 90732-3255

Mailing address

1499 W 1St St
San Pedro, CA 90732-3255
Phone (310) 831-9482

Other identifiers 1

IdentifierTypeStateIssuer
00G420810MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cpisano196687@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100310000675 CA Practitioner - Internal Medicine 6305981606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Davis School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Laguna Niguel, CA 92677

1499 W 1St St
San Pedro, CA 90732-3255
Phone (310) 831-9482

21501 Avalon Blvd
Suite 100
Carson, CA 90745-2210
Phone (310) 835-6627

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G42081CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Institute Internal Medicine Current Accepting new patients
Providence Medical Institute Internal Medicine CurrentSince Mar 1, 2010 Accepting new patients
Providence Medical Institute Internal Medicine CurrentSince Mar 1, 2010 Accepting new patients
Providence Health System Southern California Past Accepting new patients

Locations

21501 Avalon Blvd
Ste 100
Carson, CA 90745
Phone (310) 835-6627

1294 W 6th St
Ste 103
San Pedro, CA 90731
Phone (310) 831-9482

1499 W 1st St
San Pedro, CA 90732
Phone (310) 241-2590

20911 Earl St
Ste 400
Torrance, CA 90503
Phone (310) 370-0007

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1144336769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 W 1ST ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323255",
            "telephone_number": "310-831-9482",
            "fax_number": "310-831-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 W 1ST ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323255",
            "telephone_number": "310-831-9482",
            "fax_number": "310-831-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PISANO",
        "first_name": "CRESCENZO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G42081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G420810",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cpisano196687@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1499 W 1st St",
            "city": "San Pedro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907323255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

Verify at the official NPI Registry.