Ron Christian Cheng Crisostomo
Individual provider Active NPI Nurse Practitioner · Elk Grove, CA
NPI 1194454900 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1194454900
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 95020601 (CA)
- Practice address
- 9306 Bennoel CT
Elk Grove, CA 95758-7620 - Phone
- (501) 838-9179
- NPI assigned
- Jun 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 16
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mark Twain Medical Center
Practice addresses (Care Compare)
768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Phone (209) 754-3521
Hospital & facility affiliations
- United Home Care of Northern California
- Iron Point Home Health Care Inc
- Mark Twain Medical Center
- Adventist Health Sonora
- Sutter Amador Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221005003697 | CA | Practitioner - Nurse Practitioner | 9931585452 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Twain Medical Center | Current |
Accepting new patients |
Locations
768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95020601 | CA | Yes |
Addresses
Primary practice location
9306 Bennoel CT
Elk Grove, CA 95758-7620
Mailing address
9306 Bennoel CT
Elk Grove, CA 95758-7620
NPI Registry JSON
{
"created_epoch": "1654560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654560000000",
"number": "1194454900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9306 BENNOEL CT",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957587620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9306 BENNOEL CT",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957587620",
"telephone_number": "501-838-9179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRISOSTOMO",
"first_name": "RON CHRISTIAN",
"middle_name": "CHENG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-07",
"last_updated": "2022-06-07",
"certification_date": "2022-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95020601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
- Matt Crager
- Samiyah Lynn Craig
- Selena Cravalho
- Sydnee Crenshaw
- Laurence Nikko Crisostomo
- Amanda Cristobal
- Amor Robianes Cristobal
- Morgan Elaine Crittendon
- Tara Crockett
- Dakota Crossley
All providers in Elk Grove, CA · Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.