NPIMap

Individual provider Active NPI

Ron Christian Cheng Crisostomo

  • Nurse Practitioner
  • Elk Grove, CA
National Provider Identifier
1194454900
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95020601 Issued in CA
Practice address
9306 Bennoel CT
Elk Grove, CA 95758-7620
Phone
(501) 838-9179
NPI assigned
Jun 7, 2022
Last updated
Jun 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95020601 CA Primary

Addresses

Primary practice location

9306 Bennoel CT
Elk Grove, CA 95758-7620

Mailing address

9306 Bennoel CT
Elk Grove, CA 95758-7620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20221005003697 CA Practitioner - Nurse Practitioner 9931585452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark Twain Medical CenterGroup PAC ID 8820073711, 27 clinicians

Practice addresses (Care Compare)

768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Phone (209) 754-3521

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Aug 4, 2022 Accepting new patients

Locations

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

Organizations & group practices 1

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.