Crystal G Addison, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601008004 Issued in MI

Practice address

1500 E Medical Center Drive
Level 4 University Hospital BLDG 1000312
Ann Arbor, MI 48109-5240

Phone

(734) 647-9291

NPI assigned

Oct 4, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1235689100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DRIVE",
            "address_2": "LEVEL 4 UNIVERSITY HOSPITAL BLDG 1000312",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095240",
            "telephone_number": "734-647-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "CRYSTAL",
        "middle_name": "G",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-04",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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.