Crystal Gayle Self, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-105083 Issued in AL

Practice address

2700 10TH Ave S Ste 444
Birmingham, AL 35205-1250

Phone

(205) 723-0088

NPI assigned

Apr 1, 2019

Last updated

May 4, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL, MS2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Smith Lake Family Care LLCGroup PAC ID 7911319777, 9 clinicians

Family First Urgent Care Alabama LLCGroup PAC ID 6406244953, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ms_cself4@landmarkhealth-direct.org

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.

• Family First Urgent Care Alabama LLC

  • Internal Medicine Physician
  • Kimberly, AL
  • NPI 1225707631
  Medicare reassignment Care Compare group NPD
• Smith Lake Family Care LLC

  • Family Nurse Practitioner
  • Jasper, AL
  • NPI 1306447776
  Medicare reassignment Care Compare group NPD
• Family First Primary Care Alabama LLC

  • Rural Health Clinic/Center
  • Morris, AL
  • NPI 1104789494
  Medicare reassignment
• Virtual Care Network LLC

  • Pain Medicine Physician
  • Oxford, MS
  • NPI 1437944618
  Medicare reassignment
• Smith Lake Urgent Care, LLC

  dba Smith Lake Family Medicine

  • Internal Medicine Physician
  • Jasper, AL
  • NPI 1447499090
  NPD (past)

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1164984035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8434 WADE RD",
            "city": "WARRIOR",
            "state": "AL",
            "postal_code": "351803064",
            "telephone_number": "205-543-6251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 10TH AVE S STE 444",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352051250",
            "telephone_number": "205-723-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "CRYSTAL",
        "middle_name": "GAYLE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-01",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-105083",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-105083",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA BOARD OF NURSING LICENSE",
            "identifier": "1-105083",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Select Physical Therapy Holdings Inc
• Select Physical Therapy of Birmingham LTD
• Select Physical Therapy of Birmingham LTD
• Select Provider Networks, Inc.
• Select Specialty Hospitals Inc (Select Specialty Hospital - Birmingham)
• Joshua David Self, MD
• Nancy Jo Self, LPC
• Ian Alexander Sellars, MD
• Alethia Sellers
• Alyssa Gayle Sellers, OTR/L

• Family Nurse Practitioner in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.