NPIMap

Individual provider Active NPI

Daniel K Crook, PA-C

  • Physician Assistant
  • Leesville, LA
National Provider Identifier
1225761471
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.A10331 Issued in LA
Practice address
1106 Port Arthur Ter
Leesville, LA 71446-4643
Phone
(337) 404-4075
Fax
(337) 446-2548
NPI assigned
Jul 6, 2022
Last updated
Nov 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.A10331 LA Primary

Addresses

Primary practice location

1106 Port Arthur Ter
Leesville, LA 71446-4643

Mailing address

1106 Port Arthur Ter
Leesville, LA 71446-4643
Phone (337) 404-4075

Other identifiers 1

IdentifierTypeStateIssuer
PA.A10331OtherLALOUISIANA STATE BOARD OF MEDICAL EXAMINERS

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL tkennedy@traina.emadirect.md Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20221118000775 LA Practitioner - Physician Assistant 5890161533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Great River Orthopedic and Sports Medicine Center IncGroup PAC ID 4385871862, 6 clinicians

Practice addresses (Care Compare)

1106 Port Arthur Ter
Leesville, LA 71446-4643
Phone (337) 404-4075

1106 Port Arthur Terrace
Leesville, LA 71446-4643

801 W Bayou Pines Dr
Lake Charles, LA 70601-7076
Phone (337) 549-7770

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Great River Orthopedic and Sports Medicine Center, Inc. CurrentSince Jul 25, 2022 Accepting new patients

Locations

801 W Bayou Pines Dr
Lake Charles, LA 70601
Phone (337) 439-3205

1106 Port Arthur Ter
Leesville, LA 71446
Phone (337) 404-4075

376 Cocoville Rd
Mansura, LA 71350
Phone 3185424821310

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 11

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

NPI Registry JSON

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1225761471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 PORT ARTHUR TER",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464643",
            "telephone_number": "337-404-4075",
            "fax_number": "337-446-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 PORT ARTHUR TER",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464643",
            "telephone_number": "337-404-4075",
            "fax_number": "337-446-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROOK",
        "first_name": "DANIEL",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.A10331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOUISIANA STATE BOARD OF MEDICAL EXAMINERS",
            "identifier": "PA.A10331",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "tkennedy@traina.emadirect.md",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1106 Port Arthur Ter",
            "city": "Leesville",
            "state": "LA",
            "country_code": "US",
            "postal_code": "714464643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.