Organization Active NPI

J. Stuart Crutchfield, M.D.,P.a.

  • Specialist
  • Tyler, TX
National Provider Identifier
1235310590
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
H6140 Issued in TN
Legal business name
J. STUART CRUTCHFIELD, M.D.,P.A.
Practice address
722 Clinic Dr
Tyler, TX 75701-2001
Phone
(909) 531-9901
Fax
(903) 531-0079
NPI assigned
Nov 15, 2007
Last updated
May 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Authorized official

Name
Mrs. Stephanie Fugate
Title
Practice Administrator
Phone
(903) 531-9901

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X H6140 TN Primary

Addresses

Primary practice location

722 Clinic Dr
Tyler, TX 75701-2001

Mailing address

722 Clinic Dr
Tyler, TX 75701-2001
Phone (909) 531-9901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000153 TX Part B Supplier - Clinic/Group Practice 4688571375 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

722 Clinic Dr
Tyler, TX 75701
Phone (903) 531-9901

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1235310590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 CLINIC DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012001",
            "telephone_number": "909-531-9901",
            "fax_number": "903-531-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 CLINIC DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012001",
            "telephone_number": "909-531-9901",
            "fax_number": "903-531-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. STUART CRUTCHFIELD, M.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "FUGATE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "903-531-9901",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "H6140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.