NPIMap

Individual provider Active NPI

Michael Paulus Crisman, PA-C

  • Physician Assistant
  • Valentine, NE
National Provider Identifier
1164532594
Registry record updated Feb 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1064 Issued in NE
Practice address
502 N Cherry St
Valentine, NE 69201-1518
Phone
(402) 376-2200
Fax
(402) 376-2219
NPI assigned
Aug 30, 2006
Last updated
Feb 3, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2010

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 1064 NE Primary

Addresses

Primary practice location

502 N Cherry St
Valentine, NE 69201-1518

Mailing address

502 N Cherry St
Valentine, NE 69201-1518
Phone (402) 376-2200

Other identifiers 1

IdentifierTypeStateIssuer
47083768800MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20100524000316 NE Practitioner - Physician Assistant 1850420241 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gothenburg Memorial HospitalGroup PAC ID 6709832983, 12 clinicians

Practice addresses (Care Compare)

910 20TH St
Gothenburg, NE 69138-1237
Phone (308) 537-3661

PO Box
Suite 469
Gothenburg, NE 69138

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Platte Nebraska Hospital Corporation CurrentSince Apr 1, 2025 Accepting new patients
Twin Rivers Urgent Care LLC CurrentSince Oct 3, 2018 Accepting new patients
Twin Rivers Urgent Care LLC CurrentSince Oct 3, 2018 Accepting new patients
Gothenburg Memorial Hospital CurrentSince Nov 1, 2018 Accepting new patients
Gothenburg Memorial Hospital CurrentSince Nov 1, 2018 Accepting new patients
Gothenburg Memorial Hospital Past Accepting new patients
North Platte Nebraska Hospital Corporation Past Accepting new patients

Locations

910 20th St
Gothenburg, NE 69138
Phone (308) 537-3661

918 20th St
Gothenburg, NE 69138
Phone (308) 537-4066

720 N Webb Rd
Grand Island, NE 68803
Phone (308) 384-2500

750 Allen Dr
Grand Island, NE 68803
Phone (308) 382-9969

3203 Osborne Dr W
Ste 101
Hastings, NE 68901
Phone (308) 384-2500

601 W Leota St
North Platte, NE 69101
Phone (308) 534-2288

510 N Green St
Valentine, NE 69201
Phone (402) 376-3770

Organizations & group practices 9

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 4

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1164532594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 N CHERRY ST",
            "city": "VALENTINE",
            "state": "NE",
            "postal_code": "692011518",
            "telephone_number": "402-376-2200",
            "fax_number": "402-376-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 N CHERRY ST",
            "city": "VALENTINE",
            "state": "NE",
            "postal_code": "692011518",
            "telephone_number": "402-376-2200",
            "fax_number": "402-376-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISMAN",
        "first_name": "MICHAEL",
        "middle_name": "PAULUS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "1064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47083768800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valentine, NE

Sources for this page

Verify at the official NPI Registry.