Active NPI
John Reams Crockarell Sr., M.D.
- Neurological Surgery Physician
- Collierville, TN
National Provider Identifier
1205008604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- M.D.5304
- Practice address
- 2645 Halle Pkwy
Collierville, TN 38017-8802 - Phone
- (901) 861-2645
- Fax
- (901) 861-2646
- NPI assigned
- Mar 26, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | M.D.5304 | TN | Primary |
Addresses
Primary practice location
2645 Halle Pkwy
Collierville, TN 38017-8802
Mailing address
2645 Halle Pkwy
Collierville, TN 38017-8802
Phone (901) 861-2645
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M.D.5304 | TN | MD | Neurological Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206489600000",
"number": "1205008604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2645 HALLE PKWY",
"city": "COLLIERVILLE",
"state": "TN",
"postal_code": "380178802",
"telephone_number": "901-861-2645",
"fax_number": "901-861-2646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2645 HALLE PKWY",
"city": "COLLIERVILLE",
"state": "TN",
"postal_code": "380178802",
"telephone_number": "901-861-2645",
"fax_number": "901-861-2646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKARELL",
"first_name": "JOHN",
"middle_name": "REAMS",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-26",
"last_updated": "2008-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "TN",
"license": "M.D.5304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collierville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.