Individual provider Active NPI

Karen Crummy, LMSW

  • Social Worker
  • Charleston, SC
National Provider Identifier
1174079693
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
12369 Issued in SC
Practice address
2100 Charlie Hall Blvd
Charleston, SC 29414
Phone
(843) 852-4100
NPI assigned
Aug 26, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 224369 MA
Social Worker 104100000X 12369 SC Primary

Addresses

Primary practice location

2100 Charlie Hall Blvd
Charleston, SC 29414

Mailing address

140 Ivy Green Way Apt 14111
Charleston, SC 29414-2809
Phone (678) 536-6935

Other identifiers 1

IdentifierTypeStateIssuer
1760596480MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
224369MAMDSocial Worker
12369SCMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1174079693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 IVY GREEN WAY APT 14111",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294142809",
            "telephone_number": "678-536-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29414",
            "telephone_number": "843-852-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMMY",
        "first_name": "KAREN",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-26",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "224369",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SC",
            "license": "12369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760596480",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.