Jared Crutcher, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.033129 Issued in IL

Practice address

3740 E Lake Ctr
Quincy, IL 62305-5805

Phone

(217) 214-4545

NPI assigned

Jun 14, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 17, 2023 through Jan 17, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jared.crutcher.p1@direct.affiniahealthcare.nextgenshare.com

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.

• Cedar Creek Dental PLLC

  • General Practice Dentistry
  • Highland, IL
  • NPI 1063132926

  General Practice

  NPD Authorized official

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1144898529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 KENTUCKY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014211",
            "telephone_number": "618-402-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3740 E LAKE CTR",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623055805",
            "telephone_number": "217-214-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUTCHER",
        "first_name": "JARED",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.033129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley David Creech, D.C.
• Dallas Cressell, LCPC
• George E. Crickard III, MD
• Cathy M Crider, RPH
• Richard Crider
• Alaysia Nicole Culbertson, ATC
• Schvon Leigh Cummings, M.D.
• Amber Curry, FNP
• Jessica Whitney Curry, M.D.
• Custom Dental Care, P.C.

• General Practice Dentistry in Quincy, IL
• Providers in Quincy, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.