Individual provider Active NPI

Landry Crabtree, NP

  • Nurse Practitioner
  • Edwardsville, IL
National Provider Identifier
1164224606
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209032207 Issued in IL
Practice address
2122 Troy Rd
Edwardsville, IL 62025-2540
Phone
(618) 433-6410
NPI assigned
Mar 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 2024047256 MO
Nurse Practitioner 363L00000X 209032207 IL Primary

Addresses

Primary practice location

2122 Troy Rd
Edwardsville, IL 62025-2540

Mailing address

PO Box 959203
Saint Louis, MO 63195-9203
Phone (618) 433-6410

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20250725002188 IL Practitioner - Nurse Practitioner 1153838123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

2122 Troy Rd
Suite 130
Edwardsville, IL 62025-2540
Phone (618) 463-7600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2024047256MOMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Aug 10, 2025 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Aug 10, 2025 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4 Memorial Dr
Ste 125
Alton, IL 62002
Phone (618) 433-6410

2122 Troy Rd
Edwardsville, IL 62025
Phone (618) 655-0386

2122 Troy Rd
Ste 130
Edwardsville, IL 62025
Phone (618) 692-9876

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1164224606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959203",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959203",
            "telephone_number": "618-433-6410",
            "fax_number": "618-433-6420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 TROY RD",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252540",
            "telephone_number": "618-433-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRABTREE",
        "first_name": "LANDRY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MO",
            "license": "2024047256",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209032207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2122 Troy Rd Ste 130",
            "city": "Edwardsville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620252540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.