Crescent Family Practice, P.a.

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

39359 Issued in NC

Legal business name

CRESCENT FAMILY PRACTICE, P.A.

Practice address

1000 Crescent Green Dr
Suite 202
Cary, NC 27511-8116

Phone

(919) 851-7867

NPI assigned

Feb 7, 2007

Organization subpart

Yes

Parent organization

MEDVANTX, INCAs reported in NPPES

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

Authorized official

Name

Mr. Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Tri - State Medical Group Inc

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Walter Bruckert, M.D.

  • Family Medicine Physician
  • Cary, NC
  • NPI 1306993019
  NPD

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1235279522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CRESCENT GREEN DR",
            "address_2": "SUITE 202",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275118116",
            "telephone_number": "919-851-7867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT FAMILY PRACTICE, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC",
        "enumeration_date": "2007-02-07",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NC",
            "license": "39359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Creasman, BCBA
• Jennifer Carter Credle, PT
• Brad J Creehan, D.C.
• Heather M Creehan, D.C.
• Kristen Kelly Crenshaw, DPT, PT, ATC, CSCS
• Crescent Family Practice, P.a.
• Jessamine Pilar Crespo- Gonzalez
• Christine Crews
• Shneira Monae Crfaton
• Aubrey Cribbs, LCSW

• Non-Pharmacy Dispensing Site in Cary, NC
• Providers in Cary, NC by specialty
• Non-Pharmacy Dispensing Site in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; 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.